Thulium laser urethrotomy and optical urethrotomy in short urethral strictures
The objective. To analyse and compare the outcomes of incision of a urethral stricture with the use of a thulium laser and optical cold knife urethrotomy in short primary bulbar urethral strictures (to 1.5 cm). Patients and methods. We carried out a prospective study that included 23 men who were followed up from June 2016 to December 2017. The inclusion criterion was a short-segment bulbar urethral stricture (<1.5 cm). The exclusion criterion was preliminary intervention, urethroplasty, bladder neck sclerosis, urogenital tract infection. Patients were divided into two groups; Group A (n = 10) included patients who underwent optical urethrotomy and group B (n = 13) included patients with thulium laser endouretomy. After surgery, each patient underwent uroflowmetry on the 3rd day after an operation, three and six months after surgery. Thulium laser urethrotomy and optical urethrotomy in short urethral strictures Results. In all, 23 patients corresponded to the inclusion criteria and one patient was excluded because of inadequate follow-up. The average length of the stricture was 1.11 ± 0.102 cm (p = 0.32) and 1.21 ± 0.151 cm in groups А and B, respectively. The average time of work in group А was 16.3 ±1.78 min, and in group В - 20.96 ± 2.23 min (p = 0.0001). Two patients in group А had urethrorrhagias after the procedure, which was resolved conservatively. In 1 patient from group А and 1 from group В 2 months after operative treatment a relapse of disease was noted. Qmax (ml/s) proved to be statistically insignificant between two groups immediately after surgery and after 3 months, but after 6 months maximum urinary flow rate was significantly higher in group В. Conclusion. From the viewpoint of the outcomes and frequency of complications both methods - laser incision and urethrotomy - are safe and effective in management of short urethral strictures. But 6 months after surgery the quality of urination is better in the group of patients, who underwent laser urethral incision, however, a longer follow-up of patients is needed to assess long-term outcomes. It is also noteworthy that a thulium laser requires great experience and is a costly alternative to optical urethrotomy.