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

Abstract

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.