ROLE OF INTRAURETHRAL TRIAMCINOLONE INJECTION IN DIRECT VISUAL INTERNAL URETHROTOMY IN THE MANAGEMENT OF ANTERIOR URETHRAL STRICTURE AND ITS EFFECT ON RECURRENCE

Abstract

INTRODUCTION: Urethral stricture is  known for a disease of recurrence since ancient egyptian times and common after internal urethrotomy[1].In modern endouroloigcal era endoscopic management takes upperhand than  more invasive procedure like urethroplasty.Anterior urethra is the  most common location for stricture urethra and bulbar urethra the  major site of stricture accounts for 45-50%[2]. Urethral stricture can have variety of etiology like trauma or iatrogenic, infection, inflammation, ischemia or unknown etiology[3].The pathophysiology behind anterior  urethral stricture manifested by a process of fibrosis which lead to a different proportions of peri-urethral corpus spongiosum tissue fibrosis known as spongiofibrosis and is associated with narrowing  in urethral caliber and ultimately reduce in the urine flow. Treatment is based on the deep incision of the fibrotic area and subsequently local re-epithelialization process to the maintainance of the urethral patency.Scar forms in the epithelial lining of urethra which result in decrease in diameter of the urethral lumen[3].Iatrogenic etiology(30-80%) or trauma  is the commonest cause than infection[4]. Different  techniques  have been described for stricture urethra but direct visual internal urethrotomy(DVIU)and instillation of triamcinolone most important additive adjuvant drug and is best suited  and remains a common procedure due to its  easy accessible, safety, simplicity, better learning curve and short  recovery.[6-8]

MATERIALS AND METHODS: Its a retrospective observational study  ontotal of 50 patients with anterior urethral stricture who underwent DVIU (Group A; n=25) and DVIU with triamcinolone injection(Group B; n=25) in the management of anterior urethral stricture disease in males.The study done  during  the period of march 2022 to march 2023 at Father Muller Medical College & Hospital,Mangalore. Results were compared between the two groups. The P-value < 0.05 considered statistically significant difference.

RESULTS: From the study we obseve that there were not any significant difference  between age and co-morbidities in both the groups. In both the group A and B the most common age was 46-60 years. In Group A and Group B it was 48% and 56% respectively (p=0.0986).Co-morbidities (Diabetes, Hypertension ,smoking)were almost similar in both  the groups. There were no significant difference in stricture location, length and causes among the two groups(p=0.627,p=0.377,p=1.000 respectively).In  DVIU group alone( group A ) patients came with recurrence are 2(8%) in  6 month, 4(16%) in 9th month, 3(12%)in 12th month and totally 9 patients (36%). In DVIU+triamcinolone  (group B) patient came with recurrence 2 in 12th month, totally 2 patient(8%).No major complication found in both  the group(p=0.837). In our study  the result found to delay the recurrence but not statistically significant (p=0.231) and recurrence rate significantly less in DVIU +triamcinolone group(8%vs 36%;p =0.041,<0.05).

CONCLUSION: Intra-urethral triamcinolone injection into the urethral stricture site to avoid fibrosis and collagen growth is a safe and effective additive therapy after direct visual internal urethrotomy. No major complications were not noted due to the triamcinolone injection. Triamcinolone injection to the stricturous site  seems to be cost effective,produce lower side effects and play a vital role to delay the time of recurrence and recurrence rate.