The Effect of Hyaluronic Acid in Preventing Recurrence of Anterior Urethral Stricture after Endoscopic Internal Urethrotomy- A Single Centre, Randomised Controlled, Single Blind Study

ABSTRACT

BACKGROUNDHyaluronidase instillation during OIU may decrease the incidence of urethral stricture recurrence.13 The exact mechanism is not known in urethral stricture, but it is used as antifibrotic agent in hypertrophic scar, keloid, and pulmonary fibrosis. Intralesional injection decreases fibroblast proliferation, collagen, and glycosaminoglycan synthesis and suppresses proinflammatory mediators in wound healing process.14 This study was conducted to see the benefits of HA for preventing recurrence of anterior urethral stricture after urethrotomy.METHODSAfter obtaining the clearance from ethical committee, 70 patients satisfying the inclusion criteria were recruited & randomly divided into 2 groups Group A (35 patients, experimental group) received hyaluronic acid (HA) instillation & Group B (35 patients, Control group) received lubricant lignocaine after EIU. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), & 24 weeks (V3) after surgery. The recurrence rate was evaluated by protocol analysis based on number of patients who completed the study. Preoperative characteristics, including the site & length of urethral stricture, were evaluated by intent-to-treat analysis. RESULTSAmong 70 patients, only 30 patients in group A & 30 patients in group B had completed the study. Significant improvement noted in both groups after surgery in every parameter with recurrence in Group A 9.43% & in Group B 22.92% (p <0.05) at V3. IPSS score at V3 were obstructive Group A - 4.03±0.65, Group B – 5.16±1.84 (p=0.0024), Irritative group A – 2.8±0.60, Group B – 3.33±1.19 (p=0.033). At V3 follow up Qmax Group A – 22.40±3.21, Group B – 18.13±3.56 (p=0.0001); Qavg Group A – 11.43±1.72, Group B – 10.43±2.2 (p=0.048); PVRV Group A – 10.16 ± 13.81, Group B – 19.33±15.90 (p=0.020); Degree of satisfaction Group A – 2.11 ± 0.38, Group B – 1.76±0.49 (p=0.0031).CONCLUSIONSHA instillation during EIU decreases the incidence of urethral stricture recurrence & improves degree of satisfaction in long term follow up without any side effect.