Use of Cutting Balloon in the Treatment of Urethral Stricture: A Novel Technique

Balloon dilation for the treatment of male urethral strictures: a systematic review and meta-analysis

OBJECTIVE

The use of minimally invasive endoluminal treatment for urethral strictures has been a subject for debate for several decades. The aim of this study was to review and discuss the safety, efficacy and factors influencing the clinical application of balloon dilation for the treatment of male urethral strictures.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Embase, Medline, Web of Science, Cochrane Library and Scopus were searched for publications published before 17 July 2022.

STUDY SELECTION

Two independent researchers screened and assessed the results, and all clinical studies on balloon dilation for the treatment of urethral strictures in men were included.

DATA EXTRACTION AND SYNTHESIS

The success rate, rate of adverse events, International Prostate Symptom Scores, maximum uroflow (Qmax) and postvoid residual urine volume were the main outcomes. Stata V.14.0 was used for statistical analysis.

RESULTS

Fifteen studies with 715 patients were ultimately included in this systematic review. The pooled results of eight studies showed that the reported success rate of simple balloon dilation for male urethral strictures was 67.07% (95% confidence interval [CI]: 55.92% to 77.36%). The maximum urinary flow rate at 3 months (risk ratio [RR]= 2.6510, 95% CI: 1.0681 to 4.2338, p<0.01) and the maximum urinary flow rate at 1 year (RR= 1.6637, 95% CI: 1.1837 to 2.1437, p<0.05) were significantly different after dilation. There is insufficient evidence to suggest that balloon dilation is superior to optical internal urethrotomy or direct visual internal urethrotomy (DVIU) (RR= 1.4754, 95% CI: 0.7306 to 2.9793, p=0.278).

CONCLUSION

Balloon dilation may be an intermediate step before urethroplasty and is a promising alternative therapy to simple dilation and DVIU. The balloon is a promising drug delivery tool, and paclitaxel drug-coated balloon dilation is effective in reducing retreatment rates in patients with recurrent anterior urethral strictures. The aetiology, location, length, previous treatment of urethral stricture may be associated with the efficacy of balloon dilation.

PROSPERO REGISTRATION NUMBER

CRD42022334403.

The Use of a Cutting Balloon for Dilation of a Fibrous Esophageal Stricture in a Cat

Esophageal strictures are uncommon in cats with causes including medications, ingestion of caustic substances, or gastroesophageal reflux under anesthesia. Bougienage and balloon dilation are the main treatments for strictures but have variable success rates. This paper describes the novel use of a cutting balloon for dilation of a fibrous stricture in a cat that was previously refractory to treatment with traditional balloon dilation.

Management of anterior urethral stricture: an evidence-based approach

PURPOSE OF REVIEW

To provide a review of the latest evidence on the management of anterior urethral strictures.

RECENT FINDINGS

A continuing role exists for urethrotomy or dilatation in the management of urethral strictures as first-line therapy in selected patients. In those patients with bulbar strictures who fail or are not suitable for these procedures, an anastomotic urethroplasty, and if not feasible a substitution urethroplasty using either a flap or oral mucosal graft either by a dorsal, lateral or ventral onlay approach should be considered. For penile strictures, a ventral onlay procedure using skin can be considered except in cases of lichen sclerosis when an onlay procedure utilizing oral mucosa provides the best results using either a one-stage or two-stage approach.

SUMMARY

Various options exist for the management of anterior urethral stricture disease. The 'reconstructive ladder' has served to guide urologists over the years. The selection of the correct procedure should be patient-centred and based on the latest evidence.