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Comparison between cold knife and laser urethrotomy for urethral stricture: a systematic review and meta-analysis of comparative trials

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Abstract

Background

Previous study compared limited number of parameters post the treatment of cold knife and laser urethrotomy for urethral stricture and controversy about the superiority of those two techniques still remains. This study aims to update the evidence and provide better clinical guidance.

Method

We systematically searched Pubmed, Embase, ClinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials for articles comparing cold knife and laser urethrotomy for urethral stricture. Parameters including maximum urinary flow (Qmax), recurrence, reoperation, complications, operation time, and Visual Analog Scale (VAS) pain score were compared using RevMan 5.3.

Results

Seven articles involving 453 patients were eventually included. The cold-knife group had better 6-month Qmax (MD – 0.95, 95% CI – 1.49 to – 0.41) and similar 3-month and 12-month Qmax compared with the laser group. No significance was observed regarding the comparison of recurrence rate. The laser group had lower risk of bleeding (OR 0.08, 95% CI 0.01–0.43), lower rate of reoperation (OR 0.39, 95% CI 0.19–0.81) and longer operation time (MD 4.09, 95% CI 3.35–4.82). There was no significant difference in terms of other complications and VAS pain score.

Conclusion

Cold knife and laser urethrotomy had similar efficacy regarding short-term and long-term recurrence rate and Qmax, except that the cold-knife group had slightly better 6-month Qmax. However, the laser group had less risk of bleeding and lower rate of reoperation but also longer operation time.

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Acknowledgements

This research is supported by Programs from Science and Technology Department of Sichuan Province (Grant No. 2018HH0153 and 2017HH0063), National key research and development program of China (Grant No. SQ2017YFSF090096) and National Natural Science Foundation of China (Grant No. 81370855, 81702536, 81770756).

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Authors and Affiliations

  1. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People’s Republic of China

    Xiaonan Zheng, Dehong Cao, Lu Yang, Jianzhong Ai & Qiang Wei

  2. West China Medical School, Sichuan University, Chengdu, Sichuan, People’s Republic of China

    Xin Han & Hang Xu

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  1. Xiaonan Zheng
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  2. Xin Han
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  5. Lu Yang
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  6. Jianzhong Ai
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Contributions

QW, JZA, LY: project designation, public funding; XNZ, XH, HX: literature search and screening; XNZ, XH: data collection; XNZ, XH, DHC: data analysis, manuscript writing/editing; All the authors read and approved the final version.

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Correspondence to Jianzhong Ai or Qiang Wei.

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Xiaonan Zheng, Xin Han and Dehong Cao authors have contributed equally to this work.

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Zheng, X., Han, X., Cao, D. et al. Comparison between cold knife and laser urethrotomy for urethral stricture: a systematic review and meta-analysis of comparative trials. World J Urol 37, 2785–2793 (2019). https://doi.org/10.1007/s00345-019-02729-3

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