Safety and efficacy of laser and cold knife urethrotomy for urethral stricture.

BACKGROUND

Endoscopic treatment for urethral stricture, including cold knife and laser, poses a major challenge to clinical practice. Both the benefits and drawbacks of these two treatments remain controversial. This article aimed to compare the efficacy and safety of laser and cold knife urethrotomy for urethral stricture.

METHODS

We searched PubMed (1966 - 2009), Embase (1980 - 2009), Cochrane Central Register of Controlled Trials (CCRCT, 2009 No.1) and Chinese Biomedical Literature Database (CBM) for laser and cold knife urethrotomy as treatment for male urethral stenosis, looking in the English literatures. Two reviewers independently screened the literatures and extracted information. Chi-square test was used for statistical analysis with SPSS15.0.

RESULTS

A total of 44 articles, including of 3230 cases was retrieved. Success rate of patients treated with laser was 74.9% compared with 68.5% for cold knife, with very similar clinical results despite a statistically significant difference (P = 0.004). The trend in success rate at a different follow-up time was similar between the two groups. No significant difference in success rate was found between the groups of repeat operation for recurrence cases, first P = 0.090 and second P = 0.459. The shorter the stricture length was (< 1 cm), the higher the success rate was (P < 0.0001). No significant difference in success rate between the laser and cold knife groups was found in neither bulbar nor membranous urethra, bulbar P = 0.660 and membranous P = 0.477. The rates of urinary incontinence, urinary extravasation, and urinary tract infection showed no significant difference (P = 0.259, P = 0.938, P = 0.653, respectively).

CONCLUSIONS

Success rates for laser and cold knife were very similar despite being statistically different, with the groups having a similar trend in success rates at different follow-up time. Stricture location and history of endoscopic intervention did impact treatment outcome but was not significantly different. The two groups showed no significant difference in major complications.