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

Previous study compared limited number of parameters post the treatment of cold knife and laser urethrotomy for urethral stricture and controversy about the superiority of those two techniques still remains. This study aims to update the evidence and provide better clinical guidance.

We systematically searched Pubmed, Embase, ClinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials for articles comparing cold knife and laser urethrotomy for urethral stricture. Parameters including maximum urinary flow (Q_max), recurrence, reoperation, complications, operation time, and Visual Analog Scale (VAS) pain score were compared using RevMan 5.3.

Seven articles involving 453 patients were eventually included. The cold-knife group had better 6-month Q_max (MD - 0.95, 95% CI - 1.49 to - 0.41) and similar 3-month and 12-month Q_max compared with the laser group. No significance was observed regarding the comparison of recurrence rate. The laser group had lower risk of bleeding (OR 0.08, 95% CI 0.01-0.43), lower rate of reoperation (OR 0.39, 95% CI 0.19-0.81) and longer operation time (MD 4.09, 95% CI 3.35-4.82). There was no significant difference in terms of other complications and VAS pain score.

Cold knife and laser urethrotomy had similar efficacy regarding short-term and long-term recurrence rate and Q_max, except that the cold-knife group had slightly better 6-month Q_max. However, the laser group had less risk of bleeding and lower rate of reoperation but also longer operation time.