Efficacy of bipolar plasmakinetic energy with an auxiliary ureteroscopy urethrotomy for urethral stricture

Objective To assess the efficacy and safety of bipolar plasmakinetic energy with an auxiliary ureteroscopy urethrotomy for urethral stricture.Methods Forty one male patients(mean age 28;range 18-69 years)with urethral stricture were treated by 27 F endoscopic bipolar plasmakinetic energy(the Gyrus system)guided by 8-9.8 F ureteroscopy(the Wolf system)from Jan 2004 to Dec 2008.The etiologies for stricture formation were trauma(27 patients),inflammation(3 patients),prostatectomy(8 pa- tients)and hypospadias repair of adult(3 patients).The mean length of stricture was 1.23 cm(ranged from 0.3 to 3.0 cm).According to the internal diameter of urethral stricture,the length of internal diameter more than 3 F were 28 patients(A group),The opposite partly received obliterative urethral strictures and false passage were 13 patients(B group).All patients were evaluated with urethrography and uroflowmetry.They were followed up between 12 months and 18 months after endoscopic urethrotomy.Results Total success rate was 78%(32/41),23 patients(11 anterior urethral stricture,10 posterior urethral stricture,2 bulbomenbraneous stricture)in A group and 9 patients(3 anterior urethral stricture,5 posterior urethral stricture,1 bulbomenbraneous stricture)in B group were successful firstly.Success rate of patients in A group was 82.1%(23/28)compared with 69.2%(9/13)in B group.Serious complications after endoscopic urethrotomy emerged.Incidence rate of adverse effects was 17.9%(5/28)in A group(including 3 urethral re-stenosis,1 urethral perforation,1 urinous infiltration)and 30.8%(4/13)in B group(including 1 stricture more than 3cm in length,1 false passage, 2 compete urethral rupture)respectively.In A group,2 patients emerged from perforation and urinous infiltration healed over with catheterization.And 3 patients received re-stenosis and 4 patients in B group owed to no tagging genuine urethral stricture were treated with surgical repair.Conclusions The fibrotic tissue of urethral strictures was effectively removed by bipolar energy.It canimprove cure rate with an auxiliary ureteroscopy.It may be suitable to the treatment of tagging genuine urethral stricture shorter than 2 cm.Bipolar plasmakinetic energy with an auxiliary ureteroscopy urethrotomy for urethral stricture could be considered as a therapeutic option in the management of urethral strictures.