Pn. Dogra et al., Core through urethrotomy with the neodymium : YAG laser for posttraumatic obliterative strictures of the bulbomembranous urethra, J UROL, 161(1), 1999, pp. 81-84
Purpose: We studied the safety and efficacy of core through urethrotomy wit
h the neodymium (Nd):YAG laser for posttraumatic obliterative strictures of
the bulbomembranous urethra.
Materials and Methods: Eight patients a mean of 27.5 years old with posttra
umatic (motor vehicle accidents) obliterative strictures of the bulbomembra
nous urethra were treated from May to December 1997. Laser treatment select
ion criteria were stricture length 2.0 cm. or less, good alignment between
the urethral ends and no history of rectal injury or erectile dysfunction.
Al patients underwent core through urethrotomy with the Nd:YAG contact lase
r delivered with the 600 mu. bare fiber at 15 to 25 W. The urethrotomy was
guided only by a metal sound introduced through the suprapubic tract.
Results: Blood loss was negligible and excellent visualization was maintain
ed throughout the procedure. Operating time ranged from 45 to 70 minutes. T
here were no perioperative complications. Hospital stay was 24 hours in the
first case and 6 to 8 hours in subsequent cases. All patients returned to
work within 5 days. Urethroscopy was performed 4 and 12 weeks after cathete
r removal in all patients. Only 1 patient required repeat internal urethrot
omy. Voiding cystourethrography revealed a stricture-free urethra in 7 case
s. At last followup 7 to 14 months (mean 10.25) after the procedure mean ma
ximum flow rate was 18.6 mi. per second (range 16.5 to 22.4) in the patient
s who were stricture-free and 11.8 mi. per second in 1 with recurrent stric
ture.
Conclusions: Core through urethrotomy with the contact Nd:YAG laser seems t
o be a safe and effective treatment option for select strictures. The hospi
tal stay is remarkably short and complications are negligible. Re-stricture
rates are likely to be low but more experience and longer followup are nee
ded.