Reviews - Incontinence & Urodynamics

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

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Received: 29 July 2025
Published: 30 September 2025
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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.

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1. Anger JT, Buckley JC, Santucci RA, et al. Trends in stricture management among male medicare beneficiaries: Underuse of urethroplasty? Urology. 2011; 77:481-5. DOI: https://doi.org/10.1016/j.urology.2010.05.055

2. Hampson LA, McAninch JW, Breyer BN. Male urethral strictures and their management. Nat Rev Urol. 2014; 11:43-50. DOI: https://doi.org/10.1038/nrurol.2013.275

3. McDougal W, Wein AJ, Kavoussi LR, et al. Campbell-Walsh Urology Eleven Edition Review: Urethral Stricture Disease. 2016.

4. Naudé AM, Heyns CF. What is the place of internal urethrotomy in the treatment of urethral stricture disease? Nat Clin Pract Urol. 2005; 2:538-45. DOI: https://doi.org/10.1038/ncpuro0320

5. Sanjaya DGR, Rizaldi F, Renaldo J. The recurrence of stricture in postoperative patients at Dr. Soetomo Hospital from 2013-2017: A Case-Control Study. J Glob Pharma Technol 2017:711-6.

6. Koc E, Arca E, Surucu B, Kurumlu Z. An open, randomized, controlled, comparative study of the combined effect of intralesional triamcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids. Dermatol Surg 2008; 34:1507-14.

7. Gupta S, Roy S, Pal DK. Efficacy of oral steroids after optical internal urethrotomy in reducing recurrence of urethral strictures. Turk J Urol. 2018;44:42-4. DOI: https://doi.org/10.5152/tud.2017.66564

8. Ahmed M, Hossain SM, Islam MT, et al. Use of intra-urethral steroid clobetasol cream to prevent the recurrence of urethral stricture after optical urethrotomy: Randomized clinical trial. Mediscope. 2019; 6:59-63. DOI: https://doi.org/10.3329/mediscope.v6i2.43154

9. Bhuiyun MHK, Al Mamun AM, Belal T, et al. Treatment of short segment anterior urethral stricture: optical internal urethrotomy (OIU) alone and OIU with triamcinolone. Bangladesh Med J. 2019;48:31-8. DOI: https://doi.org/10.3329/bmj.v48i1.50189

10. Abdallah HM, Abuelnaga M, Rasmy AG. Intraurethral steroid injection following visual internal uerthrotomy in the management of anterior urethral strictures. QJMA Int J Med 2020;113:hcaa070-002. DOI: https://doi.org/10.1093/qjmed/hcaa070.002

11. Hosseini J, Kaviani A, Golshan AR. Clean intermittent catheterization with triamcinolone ointment following internal urethrotomy. Urol J. 2008; 5:265-8.

12. Tabassi KT, Yarmohamadi A, Mohammadi S. Triamcinolone injection following internal urethrotomy for treatment of urethral stricture. Urol J. 2011; 8:132.

13. Sterne JAC, Savovic J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. DOI: https://doi.org/10.1136/bmj.l4898

14. Mazdak H, Izadpanahi MH, Ghalamkari A, et al. Internal urethrotomy and intraurethral submucosal injection of triamcinolone in short bulbar urethral strictures. Int Urol Nephrol. 2010; 42:565-8.

15. Benson CR, Li G, Brandes SB. Long term outcomes of one-stage augmentation anterior urethroplasty: a systematic review and metaanalysis. Int Braz J Urol. 2021;47:237-50. DOI: https://doi.org/10.1590/s1677-5538.ibju.2020.0242

16. Sharpe JR, Finney RP. Urethral strictures: treatment with intralesional steroids. J Urol. 1976; 116:440-3. DOI: https://doi.org/10.1016/S0022-5347(17)58850-3

17. Uemura S, Hutson JM, Woodward AA, et al. Balanitis xerotica obliterans with urethral stricture after hypospadias repair. Pediatr Surg Int. 2000; 16:144-145. DOI: https://doi.org/10.1007/s003830050047

18. Castañón García-Alix M, Carrasco Torrens R, Muñoz Fernández ME, et al. Treatment with triamcinolone cetonide (trigondepot) for stenosis after surgery of severe hypospadias. [In Spanish].Actas Urol Esp. 2000; 24:347-50. DOI: https://doi.org/10.1016/S0210-4806(00)72459-4

19. Jiang T, Zhou X, Chen Z, et al. Clinical efficacy of submucosal injection of triamcinolone acetonide in the treatment of type II/III interstitial cystitis/bladder pain syndrome. BMC Urol. 2020; 20:1-6. DOI: https://doi.org/10.1186/s12894-020-00597-3

20. Partin AW, Wein AJ, Kavoussi LR, et al. Campbell Walsh Wein Urology, E-Book. Elsevier Health Sciences; 2020.

21. Koc E, Arca E, Surucu B, Kurumlu Z. An open, randomized, controlled, comparative study of the combined effect of intralesional tri- amcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids. Dermatol Surg 2008; 34:1507-1514. DOI: https://doi.org/10.1111/j.1524-4725.2008.34314.x

22. Zhang K, Qi E, Zhang Y, et al. Efficacy and safety of local steroids for urethra strictures: A systematic review and meta-analysis. J Endourol. 2014; 28:962-968. DOI: https://doi.org/10.1089/end.2014.0090

23. Richters CD, Paauw NJ, Mayen I, et al. Administration of prednisolone phosphate-liposomes reduces wound contraction in a rat partial-thickness wound model. Wound Repair Regen 2006; 14:602-7. DOI: https://doi.org/10.1111/j.1743-6109.2006.00167.x

24. Korhonen P, Talja M, Ruutu M, Alfthan O. Intralesional corticosteroid injections in combination with internal urethrotomy in the treatment of urethral strictures. Int Urol Nephrol. 1990; 22:263-9. DOI: https://doi.org/10.1007/BF02550404

25. Lawrence WT, MacDonagh RP. Treatment of urethral stricture disease by internal urethrotomy followed by intermittent ‘low-friction’self-catheterization: preliminary communication. J R Soc Med. 1988; 81:136-139. DOI: https://doi.org/10.1177/014107688808100306

26. Tavakkoli Tabassi K, Mansourian E, Yarmohamadi A. One-stage transperineal repair of pan-urethral stricture with dorsally placed buccal mucosal grafts: results, complications, and surgical technique. Urol J. 2011; 8:307-312.

27. Mazdak H, Izadpanahi MH, Ghalamkari A, et al. Internal urethrotomy and intraurethral submucosal injection of triamcinolone in short bulbar urethral strictures. Int Urol Nephrol. 2010; 42:565-8. DOI: https://doi.org/10.1007/s11255-009-9663-5

28. Tavakkoli Tabassi K, Mansourian E, Yarmohamadi A. One-stage transperineal repair of pan-urethral stricture with dorsally placed buccal mucosal grafts: results, complications, and surgical technique. Urol J. 2011; 8:307-312.

29. Mundy AR, Andrich DE. Urethral strictures. BJU Int. 2011;107:6-26. DOI: https://doi.org/10.1111/j.1464-410X.2010.09800.x

30. Gücük A, Tuygun C, Burgu B, et al. The short-term efficacy of dilatation therapy combined with steroid after internal urethrotomy in the management of urethral stenoses. J Endourol. 2010; 24:1017-21. DOI: https://doi.org/10.1089/end.2009.0233

Dimas Panca Andhika, Department of Urology, Faculty of Medicine, Airlangga University, Surabaya

Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Airlangga University, Surabaya; 
Universitas Airlangga Hospital, Surabaya, Indonesia

 

Tarmono Djojodimedjo, Department of Urology, Faculty of Medicine, Airlangga University, Surabaya

Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia

Furqan Hidayatullah, Department of Urology, Faculty of Medicine, Airlangga University, Surabaya

Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia

Zakaria Aulia Rahman, Department of Urology, Faculty of Medicine, Airlangga University, Surabaya

Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia

Ilham Akbar Rahman, Department of Urology, Faculty of Medicine, Airlangga University, Surabaya

Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia

Prima Ardiansah Surya, Department of Urology, Faculty of Medicine, Airlangga University, Surabaya

Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia

Mohammad Ayodhia Soebadi, Department of Urology, Faculty of Medicine, Airlangga University, Surabaya

Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia

How to Cite



Triamcinolone application following internal urethrotomy for reducing urethral stricture recurrence rate: a systematic review and meta-analysis of randomized controlled trials. (2025). Archivio Italiano Di Urologia E Andrologia, 97(3). https://doi.org/10.4081/aiua.2025.14203