INTRALESIONAL TRIAMCINOLONE ACETONIDE AS AN ADJUNCT TO DIRECT VISUAL INTERNAL URETHROTOMY FOR SHORT ANTERIOR URETHRAL STRICTURE: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

Abstract

Background. Direct visual internal urethrotomy (DVIU) is widely used for short anterior urethral stricture, but recurrence due to recurrent fibrosis remains a major limitation. Intralesional triamcinolone has anti-inflammatory and anti-fibrotic effects that may suppress restricture formation. Methods. This prospective randomized controlled study included men aged 18–65 years with symptomatic anterior urethral stricture ≤2 cm confirmed by retrograde urethrography. Patients were allocated 1:1 to DVIU plus intralesional triamcinolone acetonide 80 mg or DVIU alone and followed for 12 months. Results. Fifty-four patients were randomized; 24 intervention patients and 26 controls were available for the 12-month endpoint. Baseline characteristics were comparable. Recurrence at 12 months was 25.0% with triamcinolone versus 53.8% with DVIU alone (p=0.048). Recurrence-free survival favored the intervention group (log-rank p=0.014). Mean time to recurrence was 9.33±1.21 versus 7.07±2.13 months (p=0.03). Qmax was higher and PVR lower during follow-up in the intervention group. No steroid-related complications were reported. Conclusion. Intralesional triamcinolone acetonide appears to be a simple and well-tolerated adjunct to DVIU that may reduce recurrence and prolong recurrence-free survival in selected patients with short anterior urethral stricture. Larger multicenter studies with longer follow-up are warranted.