Is the laser mightier than the sword? A comparative study for the urethrotomy

Coen Holzhauer, Anita W. T. M. Roelofs, Arjen C. Kums, Philip C. Weijerman, Michael R. van Balken

The knife is the most common used instrument for endoscopic urethrotomy. Unfortunately, there are high recurrence rates; it is thought that a laser reduces those rates. We compared the two techniques in this retrospective study. Between 2010 and 2014, 127 patients were operated on with the knife (KG) and for 65 patients, the laser (LG) was used. We scored the complexity of the stricture using the UREThRAL stricture score (USS) and we scored if a treatment was successful. A failure was determined as recurrence, but also starting clean intermittent catheterization was stated as failure. There was no difference in USS between the two groups (KG: 5.7 vs LG: 6.0); the laser was more often used in a patient with a recurrence stricture (25.2 vs 43.1%). No difference was found in postoperative increase in flow-rate (9.5 vs 10.5 ml/sec), the number of complications (all Clavien I and one Clavien III in the KG) or the failure rate (58.3 vs 68.8%). When looked separately at patients treated for primary stricture and for a recurrence (96.7 vs 91.2%), no differences were found. There were no significant differences between knife and laser. With costs taken in consideration, we would advise treatment with the knife. Our results also show a high failure rate, especially in the recurrence group. Therefore, in case of recurrence, an open reconstruction should be considered.