COMPARATIVE STUDY BETWEEN LASER (HOLMIUM YAG) AND COLD KNIFE OPTICAL URETHROTOMY FOR THE TREATMENT OF BULBAR URETHRAL STRICTURE

Introduction: For short segment bulbar urethral stricture, two of the most popular endoscopic procedures are holmium YAG laser urethrotomy and cold knife optical urethrotomy. The Holmium YAG laser makes a precise cut in tissue with little harm to the surrounding area, whereas cold knife optical urethrotomy makes a direct cut through the stricture using a cold blade that can be seen directly through an endoscope. Both methods are thought to work well and be safe, but there is still a lot of discussion regarding whether one works better to improve symptoms and keep them from coming back. Materials & Methods: This quasi-experimental study was done in Department of Urology Allied-II Hospital, Faisalabad from August 2025 to January 2026. Males aged 18-70 years with a diagnosis of bulbar urethral stricture measuring ≤ 2cm were included. Patients with alternative etiologies of bladder outlet obstruction resulting in lower urinary tract symptoms (LUTS), numerous or recurring urethral strictures, bulbar urethral strictures exceeding 2cm, and pelvic fracture urethral damage were excluded. The treating surgeon's decision and the patient's preference determined which of two groups the patients were put in: Group A: Patients receiving Holmium:YAG laser urethrotomy; Group B: Patients receiving cold knife optical internal urethrotomy. A standardized Lower Urinary Tract Symptoms (LUTS) score by IPSS was used to record the intensity of baseline symptoms. Patients in both groups were monitored on day 7, at 6 weeks, and at 3 months post-procedure. Results: The mean values of Qmax, PVR, and IPSS before surgery were 9.31 ± 2.01 mL/s, 92.32 ± 23.91 mL, and 19.49 ± 3.91 in group A, and 8.92 ± 2.72 mL/s, 95.69 ± 31.26 mL, and 21.32 ± 2.89 in group B. In group A, the post op values were 28.31 ± 5.68 mL/s, 21.89 ± 6.72 mL, and 6.89 ± 3.15. In group B, they were 23.59 ± 6.74 mL/s, 28.69 ± 7.42 mL, and 9.32 ± 4.21. The early recurrence rates were found to be 11.43% (n=8) in group A and 31.43% (n=22) in group B. Conclusion: Holmium laser urethrotomy may be the best option, especially for bulbar urethral strictures, based on the demonstrated decreased recurrence rates, less complications, and better functional results.