Category: Endoscopic

MP21-8 - Associated factors in urethral stricture recurrence after endoscopic urethrotomy. Comparison of Holmium laser vs cold knife in a reference hospital in Mexico

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : Urethral stenosis is one of the most difficult pathologies in the urological field.  Currently, the two most common endoscopic techniques are cold knife and holmium laser urethrotomy. The purpose of our study is to identify associated factor with recurrence in both techniques in the Mexican population


Methods : This is a retrospective study carried out in the Department of Urology of the Hospital Central Militar of Mexico with approval of the ethics committee for the review of clinical records of all patients undergoing an internal urethrotomy between the period of February 2012 and June 2016. In this study, only patients undergoing internal urethrotomy with holmium laser or cold cut were taken into account for the management of urethral stricture; those who underwent a urethroplasty or urethral balloon dilation were excluded.


Results : We identified 181 patients undergoing internal urethrotomy in the designated period, of which 107 (59%) were managed with holmium laser and 74 (41%) with cold knife.  Regarding the causes of stenosis were identified for Endourological reasons in 77 patients (42%), the placement of transurethral catheters in 28.2% and radical prostatectomy with 22.7%. The site where the greatest stenosis was generated was bulbar with 86% with respect to membranous (14%). An average length of 5 mm ± 4.5. When carrying out the bivariate analysis, people under 60 years of age presented 59% excess recurrence risk compared to people older than 60 years (Confidence interval 95% CI: 0.82 - 3.05) p = 0.1623, patients with overweight and obesity presented 73% excess risk compared to normal weight (95% CI: 0.88 - 3.38) p = 0.1091; patients who presented active smoking identified 72% of excess risk of recurrence compared to those who did not smoked (95% CI: 0.90 - 3.23) p = 0.0955, in patients with a length greater than 10 mm they presented 5 times higher risk compared to those shorter than 10 mm (95% CI: 2.75 - 11.30) p= < 0.0001.
When carrying out the multivariate analysis, a 2 times higher risk of recurrence was identified with the cold knife technique compared to the holmium laser (95% CI: 1.073-4,964) p = 0.032.


Conclusions : In this study, a greater association to recurrence was identified using the procedure with cold knife compared with laser holmium, recurrences were presented after 3 months in both study groups, however, it was presented earlier with a cold cut 4 months in comparison to laser

Josè Alfredo Ruìz Hernàndez

Resident
Hospital Central Military
Mèxico, Queretaro de Arteaga, Mexico

Josè Gadu Campos Salcedo

Chief Service
Hospital Central Militar
Mexico, Distrito Federal, Mexico

Julio Cèsar Lòpez Silvestre

Mexico, Distrito Federal, Mexico

Sergio Alberto Gil Villa

Mèxico, Distrito Federal, Mexico