Role of intralesional steroid and hyaluronidase injection in reducing recurrence of urethral stricture after direct visual internal urethrotomy: A prospective study.

UNLABELLED: To evaluate the role of intralesional steroid and hyaluronidase injection after direct visual internal urethrotomy in short segment (⩽2 cm) anterior urethral strictures.

MATERIALS AND

METHODS

A prospective, interventional, randomized study involved 100 patients who underwent direct visual internal urethrotomy for short anterior urethral stricture (⩽2 cm). Patients were randomized into two groups: Group A where all patients had received intralesional triamcinolone and hyaluronidase and Group B where no intralesional injection was given after doing direct visual internal urethrotomy. Postoperatively, all patients were trained for clean intermittent self-dilatation (CISD) using a 14 Fr Foley catheter. Follow-up uroflowmetry was conducted on postoperative day 7 and at 1, 3, 6 and 12 months or when had symptoms such as poor stream of urine, acute urinary retention. Success was defined as Qmax > 12 mL/s for a minimum voided volume of 150 mL and absence of voiding symptoms.

RESULTS

The recurrence rate was 24% in Group A compared to 46% in Group B, with a 22% absolute risk reduction (p = 0.021). The mean time to recurrence was 9.4 ± 2.5 months in Group A versus 7.5 ± 2.2 months in Group B (p = 0.039). The mean Qmax at 6 and 12 months post-DVIU were significantly higher in Group A (15.5 and 14.6 mL/s) than in Group B (14.6 and 13.6 mL/s), with p-values of 0.006 and 0.002 respectively.

CONCLUSION

Intralesional injection of triamcinolone and hyaluronidase following DVIU significantly reduces the recurrence rate, delays the time to recurrence and improves peak urinary flow rate in patients with short-segment (⩽2 cm) anterior urethral strictures compared to DVIU alone.