Comparison of Holmium Laser and Cold Knife Internal Urethrotomy in the Treatment of Urethral Strictures: A Retrospective Study

Objective: This retrospective study aimed to compare the efficacy and safety of Holmium:YAG laser urethrotomy with conventional cold knife internal urethrotomy in the treatment of urethral strictures, with particular attention to stricture location and its impact on treatment outcomes, as well as the specific effects on continence in patients with membranous urethral strictures. Material and Methods: The study included 612 male patients with primary urethral strictures (membranous, bulbar, or penile). Patients were divided into 2 groups: Group 1 (n=304) underwent cold knife internal urethrotomy, and Group 2 (n=308) received Holmium:YAG laser urethrotomy. Preoperative evaluation, standardized surgical techniques, and postoperative followup were conducted. Outcomes were measured objectively and subjectively using recurrence rates, functional parameters, and quality of life assessments. Results: The holmium laser group exhibited significantly lower recurrence rates compared to the cold knife group (16.9% vs. 32.2%, p<0.001), with marked differences noted in membranous urethral strictures (19.6% vs. 38.4%, p<0.001). Improvements in functional outcomes such as maximum flow rate, International Prostate Symptom Score, and post-void residual volume were greater with the laser technique. Additionally, the incidence of post-procedure stress urinary incontinence was lower in the laser group for membranous urethral strictures (4.9% vs. 12.7%, p=0.008). Conclusion: Holmium: YAG laser urethrotomy suggests superior outcomes over cold knife urethrotomy in managing urethral strictures, yielding lower recurrence rates, reduced complications, and enhanced functional outcomes and quality of life, notably for patients with membranous urethral strictures.