title: Efficacy of holmium laser urethrotomy and intralesional injection of Santosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase and N-acetyl cysteine) on the outcome of urethral strictures.
abstract: BACKGROUND
  To study the efficacy of holmium laser urethrotomy with intralesional injection of Santosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase and N-acetyl cysteine) in the treatment of urethral strictures.
  
  
  METHODS
  A total of 50 patients with symptomatic urethral stricture were evaluated by clinical history, physical examination, uroflowmetry and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy, followed by injection of tetra-inject at the urethrotomy site. Tetra-inject was prepared by diluting acombination of 40 mg Triamcinolone, 2 mg Mitomycin, 3000 UHyaluronidase and 600 mg N-acetyl cysteine in 5-10 ml of saline, according to the stricture length. An indwelling 18 Fr silicone catheter was left in place for 7-10 days.All patients were followed-up for 6-18 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram and micturating urethrogram every 3 months.
  
  
  RESULTS
  41 (82%) patients had asuccessful outcome,whereas 9 (18%) had recurrences during a follow-up ranging from 6-18 months. In <1 cm length strictures, the success rate was 100%, while in 1-3 cm and >3 cm lengthsthe success rates were 81.2% and 66.7% respectively. This modality, thus, has an encouraging success rate, especially in those with short segment urethral strictures (<3 cm).
  
  
  CONCLUSIONS
  Holmium laser urethrotomy with intralesional injection ofSantosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase, N-acetyl cysteine) is a safe and effective minimally-invasive therapeutic modality for short segment urethral strictures.
authors: Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Santosh
authors: S
authors: Kumar
authors: Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Lalit
authors: L
authors: Kishore
authors: Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Aditya Prakash
authors: AP
authors: Sharma
authors: Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Nitin
authors: N
authors: Garg
authors: Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Shrawan Kumar
authors: SK
authors: Singh
keywords: Hyaluronidase; Mitomycin C; N-acetyl cysteine; Triamcinolone; tetra-inject