Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife

Aboulela, Waseem; ElSheemy, Mohammed S.; Shoukry, Mahmoud; Shouman, Ahmed; Shoukry, A; Ghoneima, Waleed; Ghoneimy, Mohamed El; Morsi, Hany A.; Mohsen, Mostafa Abdel; Badawy, Hesham

doi:10.1007/s11255-018-1809-x

Cited by 13 publications

(14 citation statements)

References 16 publications

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“…After applying selection criteria, 22 articles reporting data on 682 patients were included into analyses. Treatment approaches varied across the studies with seven articles reporting on urethrotomy or dilation (4–10), 11 articles reporting on urethroplasty (11–21), and four articles reporting on both techniques in comparative analyses (22–25). A summary of all articles considered for this review is depicted in Tables 1–3.…”

Section: Methodsmentioning

confidence: 99%

Section: Endoscopic Treatmentmentioning

confidence: 99%

“…Overall, seven studies reported on outcomes after endoscopic treatment (urethrotomy or dilation) (4–10) and four studies reported on comparative outcomes following endoscopic treatment vs. urethroplasty (22–25) (Tables 2, 3). Of note, only two articles performed a (partially) prospective data collection (4, 10) and thus, the level of evidence was low. The chosen definition of treatment success was heterogeneous, whereas most authors used the relatively easily assessable definition of asymptomatic voiding and no clinical symptoms (4, 5, 7, 8, 10, 23–25).…”

Section: Endoscopic Treatmentmentioning

confidence: 99%

“…The chosen definition of treatment success was heterogeneous, whereas most authors used the relatively easily assessable definition of asymptomatic voiding and no clinical symptoms (4, 5, 7, 8, 10, 23–25). Two studies did not define treatment success at all (6, 22), and seven articles chose radiographic evidence of urethral patency or no further need of any intervention as an adjunct definition of a successful surgery (4, 5, 8–10, 24, 25). The average cumulative success rate of urethrotomy or dilation in 334 patients (Tables 2, 3) was 46% (range: 21–75).…”

Section: Endoscopic Treatmentmentioning

confidence: 99%

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Anterior Urethral Strictures in Children: Disease Etiology and Comparative Effectiveness of Endoscopic Treatment vs. Open Surgical Reconstruction

2019

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Pediatric anterior urethral strictures are rare and recommendations regarding treatment strategies derive from small monocentric case series. In 2014, a collaborative effort of the Société Internationale d'Urologie and the International Consultation on Urological Diseases drafted the first systematic and evidence-based guideline for diagnosis and treatment of urethral strictures in children. Against this backdrop, we performed an updated literature review to provide a comprehensive summary of the available evidence and contemporary outcomes with a focus on comparative effectiveness of endoscopic treatment (dilation or urethrotomy) vs. open surgical reconstruction. Overall, 22 articles reporting on children with anterior urethral strictures were included into the review. Most strictures were iatrogenic (48%) and traumatic (34%), whereas congenital (13%), inflammatory (4%), or postinfectious strictures (1%) were rather rare. The cumulative success rate of endoscopic treatment and urethroplasty was 46% (range: 21–75; N = 334) and 84% (range: 25–100; N = 347), respectively. After stratifying patients according to urethroplasty technique, success rates were 82% (range: 25–100; N = 206) for excision and primary anastomosis, 94% (range: 75–100; N = 40) for graft augmentation, 97% (range: 87–100; N = 30) for flap urethroplasty, and 70% (one study; N = 20) for pull-through urethroplasty. In conclusion, endoscopic approaches are rather ineffective in the long-term and open surgical reconstruction via urethroplasty should be preferred to avoid multiple, repetitive interventions. Future research may involve multi-institutional, collaborative, and prospective studies, incorporating well-defined outcome criteria and assessing objective surgical endpoints as well as patient-reported functional outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Endoscopic Treatmentmentioning

confidence: 99%

Section: Endoscopic Treatmentmentioning

confidence: 99%

Section: Endoscopic Treatmentmentioning

confidence: 99%

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Anterior Urethral Strictures in Children: Disease Etiology and Comparative Effectiveness of Endoscopic Treatment vs. Open Surgical Reconstruction

2019

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“…No significant difference was found between the two groups in the first publications (2). However, as a result of the advances in laser technology, increased experience and more studies conducted, significant differences are observed between the two groups in recent publications (3,4).…”

Section: Introductionmentioning

confidence: 99%

Üretra darlığında endoskopik cerrahi; Bıçağa karşı lazer

Solakhan¹,

Bayrak²

2020

Yeni Üroloji Dergisi

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Üretra darlığının endoskopik cerrahisinde cold knife üretrotomi ile laser üretrotominin etkinliğini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Toplam 171 hasta retrospektif olarak değerlerlendirildi. Çalışma kapsamında verileri tam olan 118 hasta 2 gruba ayrıldı (grup 1; n=53 cold knife üretrotomi, grup 2; n= 65 lazer üretrotomi). Darlığın uzunluğu, operasyon süresi, preoperatif ve postoperatif 3., 6. ve12. aylardaki Qmax değerleri, nüks olup olmadığı ve komplikasyon varlığı (kanama, extravazasyon, ateş gb) açısından iki grup karşılaştırıldı. Bulgular: Operasyon zamanının cold knife üretrotomi yapılan hastalarda daha kısa olduğu görüldü (14.01 ± 3.86 dk vs 25.03 ± 4.43 dk, p=0.001). Postoperatif 3., 6., ve 12. aylardaki Q max değerlerinin lazer üretrotomi yapılan hastalarda daha yüksek olduğu görüldü (p=0.03, p=0.001, p=0.001). Bir yıllık takip sonucunda grup-1' de 28 (52.83%) hastada nüks saptanırken, grup-2' de 12 (18.46%) hastada nüks geliştiği gözlendi (p=0.01). Postoperatif komplikasyonlar açısından her iki grup arasında istatiksel olarak anlamlı fark izlenmedi. (p=0.209). Sonuç: Yaptığımız bu çalışmada üretra darlığını endoskopik cerrahisinde, lazer üretrotomi tekniğinin, cold knife üretrotomiye göre yüksek Qmax değerlerine ve daha düşük nüks oranına sahip olması nedeniyle daha başarılı bir cerrahi yöntem olduğu saptanmıştır. Sonuçların prospektif, randomize çalışmalarla desteklenmesi gerekmektedir.

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Comparison between cold knife and laser urethrotomy for urethral stricture: a systematic review and meta-analysis of comparative trials

et al. 2019

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Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife

Abstract: Laser VIU has a higher success rate than cold knife VIU for urethral strictures ≤ 1.5 cm in children with significantly higher Q. Both are easy to perform, low invasive and safe.

Cited by 13 publications

References 16 publications

Anterior Urethral Strictures in Children: Disease Etiology and Comparative Effectiveness of Endoscopic Treatment vs. Open Surgical Reconstruction

Anterior Urethral Strictures in Children: Disease Etiology and Comparative Effectiveness of Endoscopic Treatment vs. Open Surgical Reconstruction

Üretra darlığında endoskopik cerrahi; Bıçağa karşı lazer

Comparison between cold knife and laser urethrotomy for urethral stricture: a systematic review and meta-analysis of comparative trials

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