The Effects of Hyaluronic Acid and Carboxymethylcellulose in Preventing Recurrence of Urethral Stricture After Endoscopic Internal Urethrotomy: A Multicenter, Randomized Controlled, Single-Blinded Study

Abstract

Background: To evaluate the effects of hyaluronic acid (HA) and carboxymethylcellulose (CMC) on the recurrence of urethral stricture after treatment with endoscopic internal urethrotomy (EIU). Methods: A total of 120 patients underwent EIU for urethral stricture. Recruited patients were randomly divided into two groups: group A and B. Patients in group A (60 patients, experimental group) received HA/CMC instillation and patients in group B (60 patients, control group) received lubricant instillation after internal urethrotomy. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), and 24 weeks (V3) after the surgery. The effectiveness of HA/CMC instillation was evaluated based on the International Prostate Symptom Score/ Quality of Life, peak urine flow rate, voided volume and postvoiding residual urine volume. The visual analogue scale (VAS) pain score and degree of satisfaction were also determined for each participant. Results: Among 120 initial participants, 53 patients in group A and 48 patients in group B had completed the experiment. VAS pain scores were 0.67 +/- 0.76 and 3.60 +/- 1.52 (p < 0.001), and degrees of satisfaction were 0.28 +/- 0.50 and 0.80 +/- 0.81 in group A and group B at 1 month after surgery (p = 0.001). The recurrence of urethral stricture was observed in five cases (9.4%) in group A and 11 (22.9%) in group B (p = 0.029). Conclusions: HA/CMC instillation during EIU may decrease the incidence of urethral stricture recurrence. In addition, the use of HA/CMC was effective in reducing pain during the early postoperative period without an adverse effect.