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

Abstract

Background: This study aimed to compare the efficacy of various injection therapy agents used in combination with internal urethrotomy in preventing fibrosis and stricture recurrence.

Materials and methods: Patients who underwent direct vision internal urethrotomy (DVIU) in our clinic between 2017 and 2022 were retrospectively screened. The patients were divided into four groups: DVIU + intralesional platelet-rich plasma (DVIU + PRP group, n = 21), DVIU + intralesional mitomycin-C (DVIU + MMC group, n = 21), DVIU + intralesional prednisolone (DVIU + prednisolone group, n = 21), and DVIU alone (control group, n = 21). The length (mm) and diameter (mm) of the recurrent urethral strictures and maximum urinary flow rate (Q_max) on uroflowmetry evaluation were measured at 1, 3, and 6 months postoperatively and compared between the four groups.

Results: Urethral stenosis recurred in two (9.5%) patients in the DVIU + PRP group, three (14.3%) in the DVIU + MMC group, seven (33.3%) in the DVIU + prednisolone group, and nine (42.9%) in the control group. The reduction in stenosis recurrence significantly differed between the four groups (p = 0.040). A significant group difference in stenosis length (p = 0.047) but not in stenosis diameter (p = 0.385) was observed in patients with recurrent stenosis. Furthermore, no significant difference in Q_max was found between the groups at 1, 3, and 6 months postoperatively (p = 0.588, p = 0.047, p = 0.067, respectively).

Conclusions: Different intralesional treatments combined with internal urethrotomy demonstrate varying efficacy in reducing urethral stricture recurrence. Considering its high success rate, low cost, and reduced side effects, PRP may be the preferred intralesional treatment option in combination with DVIU.