Korean J Urol.  2010 Dec;51(12):853-857.

Early Experience with Hyaluronic Acid Instillation to Assist with Visual Internal Urethrotomy for Urethral Stricture

• Kim HM
• Kang DI
• Shim BS
• Min KS

Abstract

PURPOSE
The clinical usefulness of hyaluronic acid (HA) instillation during visual internal urethrotomy (VIU) for decreasing the incidence of recurrent urethral stricture was assessed.
MATERIALS AND METHODS
Twenty-eight patients were treated by VIU with HA instillation between May 2007 and June 2009. After insertion of a Foley catheter following urethrotomy, HA was instilled via an 18-gauge tube catheter between the urethral lumen and Foley catheter. Seventeen cases were analyzed retrospectively 12 months postoperatively. We evaluated the success rate of this procedure by comparing retrograde urethrography (RGU) results, maximum flow rates, and postvoid residual urine volumes preoperatively and 3 and 12 months postoperatively. Success was defined as either a maximum flow rate of at least 15 ml/s or no visible urethral stricture on RGU at 12 months postoperatively.
RESULTS
Total success rates were 76.5% (13/17) and 52.9% (9/17) at 3 and 12 months postoperatively, respectively. By etiology, success rates at 3 and 12 months postoperatively, respectively, were 66.7% and 33.3% for inflammation, 66.7% and 50.0% for trauma, and 83.3% and 66.7% for unknown causes. Success rates were 63.6% for strictures less than 10 mm in length and 33.3% for strictures of 10 mm or more in length at 12 months postoperatively. Success rates were 61.5% for single strictures and 25% for multiple strictures at 12 months postoperatively.
CONCLUSIONS
The success rate of VIU with HA instillation was not better than that observed in the literature for conventional VIU.

Keyword

Hyaluronic acid; Surgery; Urethral stricture

MeSH Terms

Catheters
Constriction, Pathologic
Humans
Hyaluronic Acid
Incidence
Inflammation
Retrospective Studies
Urethral Stricture
Hyaluronic Acid

Reference

1. Byun JS, Song JM. Ten years experience of post-traumatic complete urethral stricture treated with endoscopic internal urethrotomy. Korean J Urol. 1996. 37:1300–1307.

2. Huh G, Jung GW, Yoon JH. Clinical assessment of visual internal urethrotomy as primary treatment of urethral stricture. Korean J Urol. 1996. 37:798–803.

3. Jordan GH, Schlossberg SM. Retik AB, Vaughan ED, Wein AJ, editors. Surgery of the penis and urethra. Campbell's urology. 2007. 9th ed. Philadelphia: Saunders;1023–1097.

4. Bullock TL, Brandes SB. Adult anterior urethral strictures: a national practice pattern survey of board certified urologists in the United States. J Urol. 2007. 177:685–690.

5. Albers P, Fichtner J, Brühl P, Müller SC. Long-term results of internal urethrotomy. J Urol. 1996. 156:1611–1614.

6. Pansadoro V, Emiliozzi P. Internal urethrotomy in the management of anterior urethral strictures: long-term followup. J Urol. 1996. 156:73–75.

7. Mazdak H, Meshki I, Ghassami F. Effect of mitomycin C on anterior urethral stricture recurrence after internal urethrotomy. Eur Urol. 2007. 51:1089–1092.

8. Shin DE, Kim CS, Rho J, Moon HY. Effect of mitomycin-C on experimentally induced urethral stricture in rats. Korean J Urol. 2009. 50:805–811.

9. Korhonen P, Talja M, Ruutu M, Alfthan O. Intralesional corticosteroid injections in combination with internal urethrotomy in the treatment of urethral strictures. Int Urol Nephrol. 1990. 22:263–269.

10. Gücük A, Tuygun C, Burgu B, Oztürk U, Dede O, Imamoglu A. The short-term efficacy of dilatation therapy combined with steroid after internal urethrotomy in the management of urethral stenoses. J Endourol. 2010. 24:1017–1021.

11. Jeon JY, Shim BS. Adjuvant therapy with Nd-YAG laser and triamcinolone injection in the treatment of urethral stricture. Korean J Urol. 1993. 34:673–678.

12. Lim R, Stucchi AF, Morrill JM, Reed KL, Lynch R, Becker JM. The efficacy of a hyaluronate-carboxymethylcellulose bioresorbable membrane that reduces postoperative adhesions is increased by the intra-operative co-administration of a neurokinin 1 receptor antagonist in a rat model. Surgery. 2010. 148:991–999.

13. Da-Silva EA, Sampaio FJ, Dornas MC, Damiao R, Cardoso LE. Extracellular matrix changes in urethral stricture disease. J Urol. 2002. 168:805–807.

14. Kim JH, Lee JH, Yoon JH, Chang JH, Bae JH, Kim KS. Antiadhesive effect of the mixed solution of sodium hyaluronate and sodium carboxymethylcellulose after endoscopic sinus surgery. Am J Rhinol. 2007. 21:95–99.

15. Chung YC, Kim BH, Chang HS, Park CH, Kim CI. Clinical evaluation of repeated internal urethrotomy in incomplete anterior urethral stricture. Korean J Urol. 2004. 45:919–923.

16. Nabi G, Dogra PN. Endoscopic management of post-traumatic prostatic and supraprostatic strictures using Neodymium-YAG laser. Int J Urol. 2002. 9:710–714.

17. Turek PJ, Malloy TR, Cendron M, Carpiniello VL, Wein AJ. KTP-532 laser ablation of urethral strictures. Urology. 1992. 40:330–334.

18. Choi SH, Lee YS, Choi NG, Kim HJ. Initial experience with endoscopic Holmium: YAG laser urethrotomy for incomplete urethral stricture. Korean J Urol. 2009. 50:246–250.

19. Harris ES, Morgan RF, Rodeheaver GT. Analysis of the kinetics of peritoneal adhesion formation in the rat and evaluation of potential antiadhesive agents. Surgery. 1995. 117:663–669.

20. Diamond MP. The Sepracoat Adhesion Study Group. Reduction of de novo postsurgical adhesions by intraoperative precoating with Sepracoat (HAL-C) solution: a prospective, randomized, blinded, placebo-controlled multicenter study. Fertil Steril. 1998. 69:1067–1074.

21. Park JS, Cha SJ, Kim BG, Choi YS, Kwon GY, Kang H, et al. An assessment of the effects of a hyaluronan-based solution on reduction of postsurgical adhesion formation in rats: a comparative study of hyaluronan-based solution and two film barriers. J Surg Res. 2009. Epub ahead of print.

22. Kim KH, Roh YH, Kim YH, Jung GJ, An WS, Kim SE, et al. The effect of an anti-adhesion agent in continuous ambulatory peritoneal dialysis (CAPD) catheter insertion operation. J Korean Surg Soc. 2010. 78:71–76.