Comparative study between thulium laser and cold knife visual urethrotomy for treatment of short bulbomembranous urethral stricture

Rehan, Mohamed Ramadan; Elnady, Esam A.; Khater, Saed; Elsayed, Ahmed Fawzi Arafat; Gawad, Ahmed M. Abdel; Freeg, Mohamed Abdel Hafeez Aly; Mahmoud, Alaa R.

doi:10.1097/md.0000000000030235

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…These 9 studies were published between 2010 and 2023 (Table 1 ). [ 6 , 8 – 10 , 14 , 23 – 25 ] Among them, 4 studies were RCTs, [ 6 , 8 , 9 , 14 ] and the other 5 studies [ 10 , 23 – 25 ] were prospective. The follow-up duration varied from 3 months to 1 year.…”

Section: Resultsmentioning

confidence: 99%

“…However, the current literature has not mentioned the superiority of 1 laser type over another. [ 3 ] In a study by Mohamed, [ 23 ] the thulium laser group was compared to the cold knife group, with a recurrence rate of 13.3% in the laser group and 25% in the cold knife group ( P = .01). Jabłonowski and colleagues [ 8 ] used a neodymium-doped yttrium aluminum garnet laser in the laser group.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of laser versus cold knife visual internal urethrotomy in the treatment of urethral stricture (stricture length <2 cm): A systematic review and meta-analysis

Chen,

Qin,

Wang

et al. 2024

Medicine

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Purpose: There is still controversy regarding the safety and efficacy of cold knife visual internal urethrotomy and laser incisions for the treatment of urethral stricture. This study aims to compare the results of postoperative long-term and short-term maximum urinary flow rates (Qmax), surgical time, postoperative complications, and 1-year recurrence rates between the cold knife and laser surgery. Methods: We searched databases including Embase, PubMed, Cochrane, and Clinical Trials.gov to identify relevant literature published in English up to September 2023. We used Stata to compare various parameters. This study is registered in PROSPERO (CRD42023471634). Nine comparative experiments were conducted, involving a total of 659 participants. Results: The laser group showed significantly better results compared to the cold knife group in terms of postoperative 12-month maximum urinary flow rate (mean differences [MD] 2.131; 95% [1.015, 3.249], P < .0001), postoperative bleeding (RR 0.277, 95% [0.079, 0.977], P = .046), and 1-year recurrence rate (RR 0.667, 95% [0.456, 0.976], P = .037). However, there were no significant differences in postoperative 6-month and 3-month Qmax, surgical time, urethral leakage complications, overall complications, and Visual Analog Scale (VAS) scores. Conclusion: The current study results suggest that laser urethral incision has greater advantages in the long-term (12 months), 1-year recurrence rate, and bleeding complications compared to cold knife urethral incision in the treatment of urethral stricture (<2 cm). Therefore, laser urethral incision may be a better choice for patients with urethral stricture.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of laser versus cold knife visual internal urethrotomy in the treatment of urethral stricture (stricture length <2 cm): A systematic review and meta-analysis

Chen,

Qin,

Wang

et al. 2024

Medicine

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“…Urethral strictures, marked by pathological and idiopathic narrowing, present challenges such as high recurrence rates and suboptimal surgical outcomes 1 , 2 . Many strictures can be traced back to congenital deformity, infective urethritis, traumatism, and iatrogenic injury 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of holmium: YAG laser internal urethrotomy versus Cold-Knife optical internal urethrotomy in the management of urethral stricture – a systematic review and meta-analysis

Chi,

Lou,

Feng

et al. 2024

International Journal of Surgery

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Objective: Urethral stricture management has posed enduring challenges in urology, demanding innovative and effective treatment modalities. This study addresses the persistent issues associated with urethral strictures, focusing on the comparative evaluation of two contemporary treatment modalities: Ho: YAG Laser Internal Urethrotomy (HIU) and Cold Knife Optical Internal Urethrotomy (CIU). Methods: A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library and ResearchGate was conducted to identify relevant studies up to November 2023. Inclusion criteria encompassed comparative studies evaluating HIU and CIU in patients with urethral stricture. Data extraction, quality assessment, and subgroup analyses were performed using standardized methods. Outcome measures included preoperative and postoperative mean the maximum urine flow rate (Qmax), mean surgical time, recurrence rates, and perioperative complications. Results: Nine articles met the inclusion criteria, and their data were analyzed using RevMan 5.4.1. Forest plots were generated for preoperative and postoperative mean Qmax, mean surgical time, recurrence rates, and perioperative complications. While postoperative mean Qmax (MD -0.06; 95% CI, -0.28–0.16; P=0.60, I2=75%) and mean surgical time (MD 2.16; 95% CI, -1.66–5.99; P=0.27, I2=98%) showed no significant differences between HIU and CIU, a trend towards lower recurrence rates (RR 0.71; 95% CI, 0.48–1.06; P=0.09, I2=46%) was observed with HIU but without statistical significance. Perioperative complications, particularly bleeding (RR 0.21; 95% CI, 0.08–0.53; P=0.001, I2=0%), favored HIU over CIU. The subanalysis indicates that for the treatment of complex urethral strictures, the two surgical methods differ in terms of mean Qmax at 6 months postoperatively (MD -2.51; 95% CI, -4.10–-0.91; P=0.002, I2=59%) and 12 months postoperatively (MD 2.62; 95% CI, 0.93–4.30; P=0.002, I2=0%). The HIU group shows a significant decrease in recurrence rate at 12 months postoperatively (RR 0.44; 95% CI, 0.21–0.92; P=0.03, I2=0%). For short-segment urethral strictures with a length ≤1.5 cm, CIU had a shorter operative time compared to the HIU (MD 4.49; 95% CI, 3.87–5.10; P<0.00001, I2=44%). Conclusion: Overall, both interventions demonstrated similar efficacy in improving postoperative mean Qmax, mean surgical time and recurrence rates. However, subanalysis indicates that in the short term, CIU is more effective than HIU in improving Qmax after complex urethral stricture surgery. In long-term Qmax follow-up after surgery, HIU is significantly higher than CIU, and HIU has a low recurrence rate. In addition, for short-segment urethral stricture (≤1.5 cm), CIU requires less time. In terms of complications, HIU has a lower risk of bleeding.

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Safety and efficacy of lasers compared to cold knife in direct visual internal urethrotomy: a systematic review and Meta-analysis

Faizan,

Mahboob,

Samad

et al. 2024

Lasers Med Sci

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Comparative study between thulium laser and cold knife visual urethrotomy for treatment of short bulbomembranous urethral stricture

Cited by 3 publications

References 30 publications

Comparison of laser versus cold knife visual internal urethrotomy in the treatment of urethral stricture (stricture length <2 cm): A systematic review and meta-analysis

Comparison of laser versus cold knife visual internal urethrotomy in the treatment of urethral stricture (stricture length <2 cm): A systematic review and meta-analysis

Comparative analysis of holmium: YAG laser internal urethrotomy versus Cold-Knife optical internal urethrotomy in the management of urethral stricture – a systematic review and meta-analysis

Safety and efficacy of lasers compared to cold knife in direct visual internal urethrotomy: a systematic review and Meta-analysis

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