Review of the role of paclitaxel urethral balloon dilation for initial treatment of newly diagnosed short bulbar strictures.

Abstract

Anterior urethral stricture disease represents a significant burden of disease for adult men and remains challenging to treat without definitive open surgery in the form of urethroplasty, which requires specialized training. Many patients, particularly outside of metropolitan centers, can struggle to access reconstructive urologists for definitive repair. Endoscopic interventions-dilation, direct vision internal urethrotomy, and traditional urethral balloon dilation (UBD)-are standard first line therapy for urethral strictures, but these endoscopic interventions have high rates of recurrence. Adjuvant therapies such as mitomycin and steroids have been studied and utilized to improve endoscopic interventions with varying success. The novel paclitaxel drug coated balloon for UBD has been reported to have significantly lower recurrence rates of urethral strictures when compared with traditional endoscopic interventions. This is evidenced by randomized control trial data for 1 through 5 years post intervention. Current American Urological Association (AUA) guidelines recommend reserving the use of drug coated UBD for recurrent short anterior urethral strictures; however, these balloons are increasingly being utilized by reconstructive and general urologists in the primary setting due to the significant improvement in recurrence free survival. Herein, the authors evaluate the historical progression of endoscopic interventions and discuss the existing data for use of drug coated balloons in the primary setting.