Holmium Laser Uretherotomy in Combination With Intralesional Steroids in Bulbar Uretheral Stricture

Study Overview
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Brief Summary
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the purpose is to evaluate the outcome of visual internal uretherotomy with Holmium laser along with intralesional steroid injection.

Detailed Description
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In this study, the investigator evaluates the efficacy of Holmium laser in combination with intra lesional steroid injection in the treatment of bulbar urethral strictures

Official Title
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Efficacy of Holmium Laser Uretherotomy in Combination With Intralesional Steroids in the Treatment of Bulbar Uretheral Stricture

Conditions
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Urethral Stricture

Intervention / Treatment
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* Procedure: Laser uretherotomy
* Procedure: Laser uretherotomy with triamcinolone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Presence of obstructive symptoms, Short segment strictures (stricture length <2 cm) as evident on radiological studies, i.e. retrograde urethrography and micturating cystourethrography. Peak flow rate on uroflowmetry less than 15 ml/s Exclusion Criteria: Complete obliteration of lumen of urethra on urethroscopy, Balanitis Xerotica Obliterans, Age less than 18 years, Multiple strictures, Active urinary tract infection, Recurrent Strictures. Prior internal uretherotomy Prior urethroplasty Pan-anterior urethral strictures Posterior stenosis Those who lost to follow up

Ages Eligible for Study
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Minimum Age: 26 Years
Maximum Age: 69 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Laser uretherotomy<br>Using Holmium laser uretherotomy only in the treatment of bulbar uretheral stricture | Procedure: Laser uretherotomy<br>* Holmium YAG Laser with pulse energy from 1-2 Joule, frequency from 10-15 Hertz and total power from 3.0 to 30.0 Watt were set up, respectively, based on the extent of the lesions. Scar tissue was incised at the position of 12-o'clock under the guidance of guidewire or ureteric catheter till fresh mucosa appeared.<br>|
| Experimental: Laser uretherotomy with intralesional steroids<br>Using holmium laser uretherotomy with injection of 80 mg of triamcinolone (diluted with normal saline to 10 ml) in the treatment of bulbar uretheral stricture | Procedure: Laser uretherotomy with triamcinolone<br>* After laser urethrotomy, 80 mg of triamcinolone (diluted with normal saline to 10 ml) will be injected by using an injection needle (5 F size and 23 G needle size) at 10 sites, 1 ml each, along the site of urethrotomy and circumferentially.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the maximum flow rate (Qmax) is >15 ml/s at 3 and 6 months after procedure | The procedure will be accepted as successful when the maximum flow rate (Qmax) is >15 ml/s. | 3 and 6 months |