الفهرس 
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Abstract
U
rethral strictures are one of the most common reasons for urological admissions. They are associated with urinary tract infections, bladder stones, fistulas, sepsis and possibly renal insufficiency. Minimally invasive surgical approaches are utilized efficiently and safely in the treatment of urethral strictures.
Visualized internal urethrotomy VIU, is one of the preferred methods due to the practical and minimally invasive nature of the procedure. One of the alternative approaches is the correction of the stricture using laser energy.
The current study aimed to evaluate the outcome of visual internal urethrotomy with a holmium: yttrium-aluminiumgarnet laser along with intralesional paclitaxel injection.
This was a prospective interventional study that was conducted at Operation ward - Ain Shams University hospitals on 60 patients attending Ain Shams University hospitals Urology clinic. Patients were allocated into either group A or group B in a 1: 1 ratio. group A consists of those who underwent laser internal urethrotomy only and group B of those who underwent laser internal urethrotomy with circumferential submucosal paclitaxel injection at the stricture site.
The results of our present study can be summarized as follows:
No significant difference between the studied groups regarding demographic and lesion characteristics.
Operation duration was significantly higher in group-B compared to group A using independent t-test with P-value 0.000.
No statistical significant differences between both groups regarding baseline I-PSS score. Both follow 3 months and follow up 6 months significantly improved in both groups compared to the baseline using repeated measures ANOVA test with P-value <0.001 for both groups. There was statistically significant improvement at 3 months if group B compared to group A running independent t-test with P-value 0.034. Yet at 6 months although I-PSS score was slightly improved in group B compared to group A with range (5-16) mean ± SD (8.9 ±3.31) for group B Vs range (6-19) mean ± SD (10.96 ±4.75) for group A yet there was no statistically significant difference in improvement between both groups running independent t-test with P-value 0.061.
No statistical significant differences between the studied groups regarding quality of life at baseline. Both follow 3 months and follow up 6 months significantly improved in both groups regarding quality of life compared to the baseline using Chi-square test with P-value <0.001 for both groups. Follow up 3 months quality of life was slightly improved in group B compared to group A yet with no statistical difference using Chi-square test with P-value 0.851. Follow up 6 months quality of life was slightly improved in group B compared to group A yet with no statistical difference using Chi-square test with P-value 0.160.
No statistical significant differences between the studied groups regarding baseline Q-average. Both follow up 3 months and follow up 6 months significantly improved in both groups compared to the baseline using repeated measures ANOVA test with P-value <0.001 for both groups. There was statistically significant improvement at 3 months if group B compared to group A running independent t-test with P-value 0.014. Yet at 6 months although Q-average was slightly improved in group B compared to group A with range (7-18) mean ± SD (10.68±2.98) for group B Vs range (6-14.6) mean ± SD (9.7 ±2.76) for group A yet there was no statistically significant difference in improvement between both groups running independent t-test with P-value 0.204.
No statistical significant differences between the studied groups regarding baseline Q-max. Both follow up 3 months and follow up 6 months significantly improved in both groups compared to the baseline using repeated measures ANOVA test with P-value <0.001 for both groups. At 3 months although Q-max was slightly improved in group B compared to group A with range (13-29) mean ± SD (17.53±3.02) for group B Vs range (10.5-27) mean ± SD (16.86 ±5.04) for group A yet there was no statistically significant difference in improvement between both groups running independent t-test with P-value 0.545. At 6 months although Q-max was slightly improved in group B compared to group A with range (11-26) mean ± SD (15.99±3.31) for group B Vs range (10-24.1) mean ± SD (14.73±4.17) for group A yet there was no statistically significant difference in improvement between both groups running independent t-test with P-value 0.209.
Recurrence after 3 months was less frequent in group-B (0%) compared to group A (7.1%) with no statistical significant difference using Chi-square test with P-value 0.143. Recurrence after 6 months was less frequent in group B (24.1%) compared to group A (32.1%) with no statistical significant difference using Chi-square test with P-value 0.501. Overall recurrence was less frequent in group B (24.1%) compared to group A (39.3%) with no statistical significant difference using Chi-square test with P-value 0.219.
In the group A, 2 patients had fever (6.7%), 2 patients had leukocytosis (6.7%) and 2 patients had urinary tract infection (6.7%). In the group B, 1 patient had extravasation (3.3%), 2 patients had bleeding per urethra (6.7%), 3 patients had fever (10%), 2 patients had leukocytosis (6.7%) and 3 patients had urinary tract infection (10%).
CONCLUSION
O
ur findings suggest that the addition of intralesional paclitaxel injection to the treatment regimen may enhance the outcomes of visual internal urethrotomy for urethral strictures, leading to improved symptom relief and reduced recurrence rates, particularly in the midterm follow-up period. Further research may be warranted to validate these promising results and explore the long-term effects of this combined approach.