Evaluation of Combined Electro Cutter with Cold Knife in the Intractable Anterior Urethral Stricture Urethrotomy

Background: Sachse cold knife is conventionally used for optical internal urethrotomy to manage urethral strictures. In this procedure, the complications and recurrence rates are relatively high. We suggest combined electro cutter and cold knife as a success alternative in the management of intractable anterior urethral strictures. Methods: In this prospective study, 87 male patients aged ≥18 years, with diagnosed intractable urethral stricture (≥2 times recurrence) who were admitted for internal optical urethrotomy during May 2010 to Jun 2013, were included. The patients were randomized into two groups: group A (electro cutter - cold knife group, n= 45) and group B (cold knife group, n= 42). In group A, internal urethrotomy was done with electro cutter - cold knife, and in group B, Sachse cold knife was used. Patients were followed up for 6 months after surgery in Outpatient Department on 15, 30 and 180 post-operative days. Results: The success rates in group A and B were 46.6% (21 out of 45 patients), and 23.80% (10 out of 42 patients), respectively (P<0.05). The complications were seen in 11% of group A and 64% of group B. At 180 days (6-month interval), the difference between mean of PFR for electro cutter -cold knife group and cold knife group was statistically significant (P<0.01). Conclusion: Combined electro cutter with cold knife urethrotomy modality is effective than conventional cold knife urethrotome in providing immediate relief in recurrent urethral strictures and has lesser complications in patients with intractable and recurrent urethral strictures.