Holmium YAG laser urethrotomy treatment for urethral strictures, our initial experience

Justinic D, Stimac G, Popovic A, Dimanovski J, Trnski D

Dept. of Urology, University Hospital ‘Sestre Milosrdnice’ Zagreb, Croatia

Optical urethrotomy was introduced by Sachse in 1973 and it has a registered long-term recurrence rate of 75-80%. This stimulated the search for new therapies with less recurrences. Several types of laser were tried: Nd:YAG, KTP, Argon, Ho:YAG, diode,… Since the end of the ’70s various types of laser are being used for the treatment of urethral stenosis.

In this paper we present our initial experience with Auriga XL Holmium YAG laser techology in the endoscopic treatment of urethral strictures. During the period from October 2011 to March 2012, 34 patients underwent the described treatment for iatrogenic urethral strictures at our department and in our experience and from the review of current biblography we draw the following conclusions.

1) The Ho:YAG laser urethrotomy is a simple, safe and effective minimally invasive therapeutic modality for urethral stricture with results comparable to those of conventional urethrotomy
2) in recent studies recurrence-free rates at 6 months, 9 months, and 12 months were significantly higher in patients after laser urethrotomy than in patients after cold-knife urethrotomy and in addition it provides shorter operating time
3) Prospective long-term studies with larger numbers of patients and longer follow-up are necessary.
4) Ho:YAG laser urethrotomy might at least be an alternative to urethroplasty in patients with high comorbidity who are not suitable for open reconstruction