Evaluation of the Efficacy and Safety of Laser versus Cold Knife Urethrotomy in the Management of Patients with Urethral Strictures: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Urol Int. 2017;99(4):453-459. doi: 10.1159/000478026. Epub 2017 Jul 12.


Introduction: Urethral strictures generate great morbidity. Two procedures have been described for their management - laser and cold knife techniques - which are still widely used. We aim to assess the safety and efficacy of laser versus cold knife urethrotomy.

Materials and methods: We conducted a systematic search of the literature using MEDLINE, EMBASE, LILACS and Cochrane databases and gray literature. Primary outcomes were urethral stricture recurrence, time-to-recurrence and complication rate. Secondary outcomes were quality of life and maximum urinary flow rate (Qmax). Data analysis was obtained using Review Manager 5.2.

Results: Out of 137 publications, 4 articles were included in the meta-analysis. At 3 months, the recurrence rate was similar in both groups (0.55, 95% CI 0.18-1.66), but at 6 and 12 months, it was significantly lower in the laser urethrotomy group (0.39, 95% CI 0.19-0.81 and 0.44, 95% CI 0.26-0.75). The analysis of Qmax at 6 months post-intervention suggested a greater improvement in the laser urethrotomy group. A qualitative analysis showed that complications in both procedures were minor and infrequent.

Conclusions: Laser urethrotomy has a lower recurrence rate at 6 and 12 months compared to cold knife urethrotomy. Complications in both procedures are minor and infrequent. Results should be interpreted cautiously, since they were evaluated only for a short term.

Keywords: Cold knife; Efficacy; Laser; Recurrence rate; Safety; Urethra; Urethral reconstruction; Urethral stenosis; Urethral stricture; Urethrotomy.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Chi-Square Distribution
  • Equipment Design
  • Humans
  • Laser Therapy / adverse effects
  • Laser Therapy / instrumentation
  • Laser Therapy / mortality*
  • Lasers / adverse effects
  • Odds Ratio
  • Postoperative Complications / etiology
  • Recurrence
  • Risk Factors
  • Surgical Instruments
  • Time Factors
  • Treatment Outcome
  • Urethral Stricture / surgery*
  • Urologic Surgical Procedures / adverse effects
  • Urologic Surgical Procedures / instrumentation
  • Urologic Surgical Procedures / methods*