Efficacy of Holmium Laser Urethrotomy vs in Combination with Intralesional Paclitaxel Injection in the Treatment of Urethral Stricture

Abstract Background Male Urethral strictures are one of the most common reasons for urological admissions. They are associated with urinary tract infections, bladder stones, fistulas, sepsis and possibly renal insufficiency. Minimally invasive surgical approaches are utilized efficiently and safely in the treatment of urethral strictures. Aim of the Work To evaluate the outcome of visual internal urethrotomy with a holmium: yttrium- aluminum- garnet laser Vs in combination with intralesional paclitaxel injection. Patients and Methods A prospective interventional study that was conducted at Ain Shams University hospitals on 60 patients attending Ain Shams University hospitals Urology clinic for 6 months. Patients were randomly allocated by closed envelop method into either Group A or Group B in a 1: 1 ratio. Group A consists of those who underwent laser internal urethrotomy only, and Group B of those who underwent laser internal urethrotomy with circumferential submucosal paclitaxel injection at the stricture site. Results There was statistically significant improvement in IPSS score at 3 months in group B compared to group A with P-value 0.034. There was statistically significant improvement in Q- average at 3 months in group B compared to group A with P-value 0.014. Q-max was slightly improved in group B compared to Group A at 3 months yet there was no statistically significant difference with P-value 0.545. Overall recurrence was less frequent in group B (24.1%) compared to group A (39.3%) with no statistically significant difference with P-value 0.219. Conclusion The addition of intralesional paclitaxel injection to the treatment regimen may enhance the outcomes of visual internal urethrotomy for urethral strictures, leading to improved symptom relief and reduced recurrence rates, particularly in the midterm follow-up period. Further research may be warranted to validate these promising results and explore the long-term effects of this combined approach.