Is There a Difference between Intralesional Treatments Combined with Internal Urethrotomy?

Area of Science:

• Urology
• Regenerative Medicine
• Surgical Innovation

Background:

• Urethral stricture recurrence after internal urethrotomy remains a clinical challenge.
• Fibrosis and scar formation contribute significantly to stricture recurrence.
• Investigating adjunctive therapies to improve outcomes of direct vision internal urethrotomy (DVIU) is crucial.

Purpose of the Study:

• To compare the efficacy of intralesional injection therapies combined with DVIU in preventing urethral stricture recurrence.
• To evaluate platelet-rich plasma (PRP), mitomycin-C (MMC), and prednisolone as adjuncts to DVIU.
• To determine the optimal intralesional agent for reducing post-DVIU urethral fibrosis and stricture recurrence.

Main Methods:

• Retrospective screening of patients undergoing DVIU between 2017-2022.
• Four patient groups: DVIU + PRP, DVIU + MMC, DVIU + prednisolone, and DVIU alone (control).
• Recurrent stricture length, diameter, and maximum urinary flow rate (Qmax) were assessed at 1, 3, and 6 months postoperatively.

Main Results:

• The DVIU + PRP group exhibited the lowest recurrence rate (9.5%), followed by DVIU + MMC (14.3%), DVIU + prednisolone (33.3%), and control (42.9%).
• A statistically significant difference in stenosis recurrence was observed among the groups (p=0.040).
• Significant differences were noted in recurrent stenosis length (p=0.047), but not diameter (p=0.385) or Qmax (p=0.047-0.588).

Conclusions:

• Intralesional treatments combined with DVIU demonstrate varying efficacy in preventing urethral stricture recurrence.
• Platelet-rich plasma (PRP) presents a highly successful, cost-effective, and safe option for intralesional therapy post-DVIU.
• PRP may be the preferred adjunctive treatment to DVIU for managing urethral strictures.