Comparative Study between Holmium Laser and Cold Knife in Optical Internal Urethrotomy for the Management of Anterior Urethral Stricture

Abstract Background Urethral stricture is a narrowing of the urethra due to many causes including, trauma, ischaemia, spongiofibrosis, inflammation, and sexually transmitted gonococcal infections, resulting in tissue scaring in the corpus spongiosum, It can occur at any point on the male urethra. Regarding urethral stricture management, many researchers and surgeons have proposed and evaluated several methods, including urethral dilation, direct vision internal urethrotomy, laser urethrotomy and urethroplasty. Aim to compare the outcomes of Holmium: yttrium-aluminium-garnet (YAG) laser urethrotomy with the conventional cold-knife technique as regards treatment outcome, efficacy and complications in cases of urethral stricture disease. Methods This prospective randomized clinical trial was conducted at Ain Shams University hospitals and Nile hospital for insurance. This study was conducted on 30 male patients with urethral stricture assigned into two equal groups; Group A: received urethrotomy with conventional cold knife. Group B received urethrotomy with Holmium: YAG laser. Results Holmium Laser modality was associated with significantly lower postoperative postvoid residual urine volume and International Prostate Symptom Score (IPSS) at 1 & 3 months postoperative and shorter operative time but there was insignificant difference as regards peak flow rate(PFR). Complications in both procedures were minor and infrequent Conclusion Holmium Laser and cold knife internal urethrotomy are effective surgical options for the treatment of anterior urethral stricture with a promising outcome after 3- months follow-up with a better success rate using the Holmium laser. Both are easy to perform, minimal invasive and safe