Comparison between cold knife and laser urethrotomy for urethral stricture: a systematic review and meta-analysis of comparative trials.

Previous study compared limited number of parameters post the treatment of cold knife and laser urethrotomy for urethral stricture and controversy about the superiority of those two techniques still remains. This study aims to update the evidence and provide better clinical guidance.

We systematically searched Pubmed, Embase, ClinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials for articles comparing cold knife and laser urethrotomy for urethral stricture. Parameters including maximum urinary flow (Qmax), recurrence, reoperation, complications, operation time, and Visual Analog Scale (VAS) pain score were compared using RevMan 5.3.

Seven articles involving 453 patients were eventually included. The cold-knife group had better 6-month Qmax (MD - 0.95, 95% CI - 1.49 to - 0.41) and similar 3-month and 12-month Qmax compared with the laser group. No significance was observed regarding the comparison of recurrence rate. The laser group had lower risk of bleeding (OR 0.08, 95% CI 0.01-0.43), lower rate of reoperation (OR 0.39, 95% CI 0.19-0.81) and longer operation time (MD 4.09, 95% CI 3.35-4.82). There was no significant difference in terms of other complications and VAS pain score.

Cold knife and laser urethrotomy had similar efficacy regarding short-term and long-term recurrence rate and Qmax, except that the cold-knife group had slightly better 6-month Qmax. However, the laser group had less risk of bleeding and lower rate of reoperation but also longer operation time.

World journal of urology. 2019 Mar 20 [Epub ahead of print]

Xiaonan Zheng, Xin Han, Dehong Cao, Hang Xu, Lu Yang, Jianzhong Ai, Qiang Wei

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China., West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China., Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China. ., Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China. .

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