Effect of local steroids on urethral strictures: A systematic review and meta-analysis

Christopher Soliman; Henry Y.C. Pan; Clancy J. Mulholland; Marc A. Furrer; Dinesh K. Agarwal; Nathan Lawrentschuk; Niranjan J. Sathianathen

doi:https://doi.org/10.4111/icu.20210391

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자료유형: 학술저널

저자정보: Christopher Soliman (The Royal Melbourne Hospital) Henry Y.C. Pan (The Royal Melbourne Hospital) Clancy J. Mulholland (The Royal Melbourne Hospital) Marc A. Furrer (The Royal Melbourne Hospital) Dinesh K. Agarwal (The Royal Melbourne Hospital) Nathan Lawrentschuk (The Royal Melbourne Hospital) Niranjan J. Sathianathen (The Royal Melbourne Hospital)

저널정보: 대한비뇨기과학회 Investigative and Clinical Urology Investigative and Clinical Urology Vol.63 No.3

발행연도: 2022.5

수록면: 273 - 284 (12page)

DOI: https://doi.org/10.4111/icu.20210391

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Purpose: Urethral stricture disease is common and has high associated morbidity and impact on quality-of-life. This systematic review and meta-analysis aims to summarise current evidence on the efficacy of local urethral steroids post-direct vision internal urethrotomy (DVIU) for the treatment of urethral strictures in males. Materials and Methods: A comprehensive search was performed using reputable databases and registries, up to 22 February 2022. Only randomised control trials in which participants were randomised to DVIU plus local urethral steroids versus DVIU only were included. Statistical analyses were performed using a random-effects model. Quality of evidence was rated according to the GRADE approach. Results: The search identified seven studies in which 365 participants were randomised to DVIU plus local urethral steroids versus DVIU only. The application of local steroids appeared to reduce recurrence rates (risk ratio, 0.67; 95% confidence interval [CI], 0.49?0.90) and time-to-recurrence (hazard ratio, 0.58; 95% CI, 0.39?0.85). Qmax also improved following steroid application (mean difference, 0.82; 95% CI, -1.02?2.66); however, this was not statistically significant. No heterogeneity was identified between included studies for all outcomes. The certainty of evidence was downgraded due to study limitations with a small sample size and unclear risk-of-bias related to insufficient trial information. Conclusions: Compared to DVIU alone, adjuvant steroids applied to the urethra may reduce risk of recurrence and time-to-recurrence. These findings were statistically significant and likely also clinically significant given low associated costs and risk. However, more robust randomised trials are necessary to enhance the validity of these outcomes.

#Male #Steroids #Urethral stricture

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