Triamcinolone application following internal urethrotomy for reducing urethral stricture recurrence rate: a systematic review and meta-analysis of randomized controlled trials

Introduction: Urethral stricture, characterized by urethral narrowing due to fibrosis and scar tissue, is a common urological condition. It occurs in about 200 per 100,000 people, with increasing incidence over the past 50 years. Internal urethrotomy is commonly performed for short strictures, but its high recurrence rate has led to the exploration of adjunctive treatments like adjunct of triamcinolone application. This study aimed to analyze the effect of triamcinolone as adjunctive therapy for internal urethrotomy on reducing urethral stricture recurrence in urethral stricture patients. Methods: A systematic search was conducted in PUBMED, ScienceDirect, and Google Scholar. This review was conducted according to the PRISMA guideline, and the protocol has been registered in the PROSPERO database (CRD42020202254). Results: Six RCTs, including 373 urethral stricture patients, were eligible for this study. Pooled results of the included studies showed a significant difference between the triamcinolone and control groups, indicating a lower recurrence rate in the triamcinolone group (OR = 0.49 95% CI 0.31-0.77, p=0.002). A significant difference was seen in the ointment with clean intermittent catheterization (CIC) intervention subgroup (OR = 0.47 CI 95% 0.26-0.82, p=0.009), but not in the submucosal injection subgroup (p>0.05). The treatment and control groups had similar maximum urinary flow rate (Qmax) at six and twelve months (p>0.05). Conclusions: Triamcinolone ointment with CIC reduced urethral stricture recurrence following internal urethrotomy, whereas submucosal injection did not. Both treatments do not increase the maximum urinary flow rate.