Optical internal urethrotomy alone versus optical internal urethrotomy with intralesional triamcinolone acetonide for short-segment anterior urethral stricture: A prospective randomised controlled trial.

Abstract

Urethral stricture recurrence after optical internal urethrotomy (OIU) is well documented, with published rates of 40%-68% at 1 year. This prospective randomised controlled trial assigned 50 male patients with primary short-segment (< 2 cm) inflammatory bulbar urethral strictures to OIU augmented by intralesional triamcinolone acetonide 40 mg (Group A, n = 25) or OIU alone (Group B, n = 25) at a tertiary urology unit in Chennai, India (January-December 2024). Primary outcome was maximum urinary flow rate (Qmax) at 1 month post-catheter removal; secondary outcome was cumulative stricture recurrence at 8 months. Baseline characteristics were comparable between groups. At 1 month, mean Qmax was 15.76 ± 1.98 ml/s in Group A versus 14.24 ± 1.98 ml/s in Group B (mean difference + 1.52 ml/s, 95% CI 0.39-2.65; p = 0.0092; Cohen's d = 0.767). Cumulative 8-month recurrence was 12% (n = 3) in Group A and 40% (n = 10) in Group B (relative risk 0.30, 95% CI 0.09-0.96; absolute risk reduction 28%; number needed to treat 3.6; Fisher exact p = 0.051). No serious adverse events were attributable to triamcinolone. Intralesional triamcinolone acetonide at the time of OIU improves early urinary flow and reduces short-term recurrence with a favourable safety profile.