Ultrasound guided urethral drug-coated balloon treatment: our experience in 20 men

To evaluate the use of urethral drug-coated balloon (DCB) in the treatmentof recurrent urethral strictures.

From January 2023 to June 2025, twenty males (median 69 years) with recurrent urethral strictures were evaluated: 7/20 (35%) had urethral-bladder neck stenosis following radical prostatectomy, 11/20 (55%) and 2/20 (10%) had bulbar and anterior stenosis. All the patients previously underwent in 19/20 cases endoscopic urethrotomy (1-3 times) and in one case urethroplasty for hyospadias; median flow max was 5/ml/sec and post voiding urine residual was 150 ml; one man had suprapubic catheter. Urethral stenosis was measured by ultrasound (US) using saline water injected through the external meatus; moreover, US guided urethral dilatation was performed. Strictures were pretreated with an uncoated balloon or by stenosis incision; the inflation of Optilume®  DCB occurred for 7 min to allow complete stricture dilation and paclitaxel delivery. Finally a 18 Ch catheter was allocated in the bladder and removed five days later. Clinical outcomes included: average Qmax, International Prostate Symptoms Score (IPSS), IPSS quality of life (QoL), International Index of Erectile Function (IEFF-5) and over time rate of repeated intervention (dilation, endoscopic urethrotomy or urethroplasty).

None had side effects during and following the procedure; all the patients improved their IPSS, IEEF-5 and none underwent repeated urethral treatment during the follow up. QoL improved together with sexual activity; although, IPPS score and flow max were improved but not restored to normal values all the patients had a good QoL refusing additional instrumental evaluation during the follow up. In detail, at a median 12 months of follow up IPSS, QoL and post-voiding urine residual and IEEF-score improved of 63%, 60%, 78% and 50%, respectively.

Although the limited number of patients evaluated and follow up, DCB demonstrated a good alternative for men with anterior and posterior urethral stenosis who have an unsuccessful endoscopic urethrotomy or dilation who want to avoid urethroplasty.