Male urethral stricture is a common condition in urological practice. The traditional therapeutic methods, including urethral dilatation and cold knife urethrotomy. The one  that is most appealing to urologists and patients is direct VIU, as  it is a minimally invasive endoscopic procedure. The aim of this study is to compare the safety and efficacy  of using Holmium:YAG laser and  the cold knife in treatment of short segment bulbar urethral stricture .

A total of 60 patients were included in this rondom prospective contolled study from April 2017 to September 2019 using retrograde endoscopic Ho:YAG laser and cold knife. They were divided into two groups,group 1 included 30 patients(18cases with stricture length <1cm and 12 more than 1cm ), each patient was submitted to conventional or cold knife urethrotomy and group 2 included 30 patients(23cases with stricture length <1cm and 7 more than 1cm ), each patient was submitted to HO:YAG laser urethrotomy. Inclusion criteria included  Fresh, short and single stricture. Exclusion criteria were, Long stricture segments more than 1.5 cm, Urethral stricture following pelvic fracture and rupture urethra, Recurrent cases after open urethroplasty or endoscopic dilatation or visual internal urethrotomy and complicated cases as those associated with diverticulum or multiple level strictures.The diagnosis of urethral stricture was based on clinical history (obstructive symptoms), uroflowmetry, and combined Antegrade and retrograde urethrography.

Mean patients’ age was 42.90±16.01 years ( range 18 - 70 years) for direct VIU cases and 41.89±12.51 years ( range23- 66 years) for the Laser VIU cases. Urethral strictures ranged from 0.5-1.5 cm long;. Mean operative time of the studied cases was 24.07±5.53 min for direct VIU and 31.25±6.18 min for Laser VIU, The mean peak urinary flow rate (Q(max)) preoperatively was 8.09± 2.00m l/s( for direct VIU cases while it was 8.78±1.70 m l/s for  Laser VIU with insignificant difference (p<0.177)

After 6 months, no recurrence occurred in 14 cases from 18 (77.8%) with less than 1 cm stricture length of direct VIU cases versus 18 cases from 23 (78.3%) with less than 1 cm stricture length of  Laser VIU cases and  this difference was not statistically significant (p=0.970). On the other side, no recurrence occurred in 5 cases from 12  (41.7%) with stricture more than 1 cm of direct VIU cases  versus 3 cases from 7 (42.9%) with more than 1 cm stricture length of Laser VIU cases which either was not statistically significant (p=0.960).

YAG laser urethrotomy (laser VIU) is a safe and effective minimally invasive therapeutic modality for short segment bulbar urethral stricture with the same results comparable to those of conventional cold knife urethrotomy(direct VIU). However, randomized comparitive studies with longer follow-up are necessary to determine the clinical value of the holmium laser in the treatment of urethral strictures.