Comparison of Internal Optical Urethrotomy with and without Intra-Lesional Injection of Triamcinolone for Management of Urethral Stricture in Term of Recurrence Rate

Abstract

BACKGROUND: Urethral stricture is an abnormal narrowing of the urethral lumen, due to a scarring process in the corpus spongiosum surrounding urothelium. The urethral stricture is a recurrent disease and presents a significant workload to urologists. The various available treatment modalities are Dilatations, Internal optical Urethrotomy and Open Urethroplasties (Anastomotic and Substitutional Urethroplasties). Internal Optical Urethrotomy (IOU) is the most commonly performed procedure for short length (<1.5cm) urethral stricture but has recurrence as its major complication. To prevent recurrence of the disease various add on drugs like triamcinolone, which has anti-proliferative effect, is used after IOU.In this study we evaluated the efficacy of triamcinolone in the prevention of recurrence of urethral stricture after IOU.

MATERIAL & METHODS: A total of 70 patients fulfilling the inclusion criteria were included in the study and randomly divided into 2 groupsat Jinnah Hospital Lahore from November 2024 to April 2025. In Group 1 patients underwent Internal Optical Urethrotomy alone, while in Group 2 patients underwent Internal Optical Urethrotomyfollowed by intra-lesional sub mucosalinjection of Triamcinolone (40mg at 1, 5, 7 and 11 O’ clock of urethra) were enrolled. All patients were followed with retrograde urethrogramafterone month and three months and stricture recurrence rate was compared with retrograde urethrogram. The data was collected and analyzed by using SPSS 23.0 version.

RESULTS: Mean age of the cases in group A (without triamcinolone) was 37.83 ± 4.84 and in group B (with triamcinolone) was 39.17± 5.79. The pre-operative evaluations of the strictureshowed that in group A (without triamcinolone) 22 (62.9%) patients has Grade 2 disease and 13 (37.1%) patients has Grade-3 disease  and group-B (with triamcinolone) has 20 (57.1%) patients with grade-2 disease and 15 (42.9%) has Grade-3 disease.  

At 01 month follow up of procedure, comparison of recurrence of grade-2 disease was statistically significant with p-value 0.045 as only group-A has recurrence of 4 (18.2%) cases to grade-2 disease. Similarly, 5 (38.5%) patients of grade-3 in group-A and 1 (6.7%) in group-B has recurrence of grade-2 disease with significant p-value 0.041.The comparison of recurrence among grade-2 disease patients of both groups, after 3 month follow up, has significant p-value 0.023. There were 5 (22.7%) patients of Grade-2 disease in Group-A with recurrence of grade-2 while no recurrence of grade-2 disease in other group. There were 6 (46.2%) patients of grade-3 disease of (group-A) and 1 (6.7%) of (Group-B)has recurrence. of grade-2 disease after 3 months with significant p-value 0.016.

CONCLUSION: Treating a urethral stricture with IOU in combination with intra-lesion triamcinolone injection has longer recurrence free period as compared to IOU alone. IOU with steroid injection is safe and successful therapy for management of urethral stricture with lower rate of recurrence of disease and grade of disease recurred is also decreased.

KEY WORDS: Urethrogram, stricture urethra, internal optical urethrotomy, Recurrence