Drug-Coated Balloon Treatment for Urethral Strictures: Is This the Future? A Review of the Current Literature

Urethral strictures significantly impact patients' quality of life, with endoscopic treatments such as direct vision internal urethrotomy (DVIU) and dilatation showing high recurrence rates. Drug-coated balloon (DCB) treatment, which delivers paclitaxel locally after dilation, is an innovative, minimally invasive approach aimed at reducing fibrosis and stricture recurrence. Paclitaxel's antiproliferative and antifibrotic properties inhibit excessive collagen deposition, improving long-term outcomes. DCB treatment is now included in guidelines for managing recurrent bulbar strictures less than 3 cm in length. Recent studies, including the ROBUST trials, have demonstrated the efficacy of Optilume in improving the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax). DCB has also shown a significant reduction in reintervention rates compared with endoscopic treatments in long-term studies, confirming its safety profile. However, the durability of DCB in complex or longer strictures remains uncertain, and its role as a salvage therapy post-urethroplasty requires further investigation. DCB represents a promising, cost-effective advancement in managing recurrent bulbar urethral strictures, particularly for patients unsuitable for urethroplasty. Future research should focus on refining patient selection criteria and exploring indications for other anatomical sites.