Introduction: The urethral syndrome is characterized by irritative disturbances, the urgency-frequency syndrome and/or pain associated with negative urine cultures. Areas of metaplasic tissue in the trigonal-bladder neck region (trigonitis) are sometimes present. We performed a comparative randomized study to assess the efficacy of side- or end-fi ring neodymium (Nd):YAG laser surgery in destroying metaplasia and relieving symptoms. Materials and Methods: Between January 1997 and December 2003, 62 consecutive women with the urethral syndrome and squamous metaplasia of the bladder neck-trigone, who were refractory to drugs, were randomly assigned to treatment with end-fi ring (group A) or side-fi ring (group B) Nd:YAG laser. Three, 6 and 12 months after surgery all patients underwent a clinical urological examination and cystoscopy. Surgery was considered successful when patients reported they were satisfi ed with the outcome or stated on the UDI-6 questionnaire that symptoms were reduced by at least 75%. Results: Group A end-fi ring laser: patients rapidly improved (2–3 weeks) but symptoms worsened within 3 months. At 6–12 months, symptoms had improved in 19% of the 31 patients and remained unchanged or worsened in 81%. Group B side-fi ring laser: irritative disturbances worsened in the 7–10 days after therapy but markedly improved within 2–3 months. Symptoms signifi cantly improved in 68% of the 28 patients and remained unchanged or worsened in 32%. Results were signifi cantly better after side-fi ring laser (p ! 0.001) and a trend towards improvements emerged as the joule levels rose. At 3 months, cystoscopy and biopsy showed squamous metaplasia was no longer present in patients whose symptoms had improved. Whitish areas were still present in the bladder neck-trigone in patients whose symptoms had remained unchanged or worsened. These patients were retreated. Conclusions: In the treatment of the urethral syndrome the few reports on attempts to restore a normal urothelium by means of diathermocoagulation and cryotherapy have been encouraging. Sidefi ring laser, which produces necrotic coagulation followed by reconstitution of normal functional epithelium, was signifi cantly more successful than end-fi ring and was associated with a 78% success rate. These results are encouraging in patients who are usually refractory to medical therapy.
Treatment of urethral syndrome: a prospective randomized study with Nd:YAG laser
Zucchi A.;
2006-01-01
Abstract
Introduction: The urethral syndrome is characterized by irritative disturbances, the urgency-frequency syndrome and/or pain associated with negative urine cultures. Areas of metaplasic tissue in the trigonal-bladder neck region (trigonitis) are sometimes present. We performed a comparative randomized study to assess the efficacy of side- or end-fi ring neodymium (Nd):YAG laser surgery in destroying metaplasia and relieving symptoms. Materials and Methods: Between January 1997 and December 2003, 62 consecutive women with the urethral syndrome and squamous metaplasia of the bladder neck-trigone, who were refractory to drugs, were randomly assigned to treatment with end-fi ring (group A) or side-fi ring (group B) Nd:YAG laser. Three, 6 and 12 months after surgery all patients underwent a clinical urological examination and cystoscopy. Surgery was considered successful when patients reported they were satisfi ed with the outcome or stated on the UDI-6 questionnaire that symptoms were reduced by at least 75%. Results: Group A end-fi ring laser: patients rapidly improved (2–3 weeks) but symptoms worsened within 3 months. At 6–12 months, symptoms had improved in 19% of the 31 patients and remained unchanged or worsened in 81%. Group B side-fi ring laser: irritative disturbances worsened in the 7–10 days after therapy but markedly improved within 2–3 months. Symptoms signifi cantly improved in 68% of the 28 patients and remained unchanged or worsened in 32%. Results were signifi cantly better after side-fi ring laser (p ! 0.001) and a trend towards improvements emerged as the joule levels rose. At 3 months, cystoscopy and biopsy showed squamous metaplasia was no longer present in patients whose symptoms had improved. Whitish areas were still present in the bladder neck-trigone in patients whose symptoms had remained unchanged or worsened. These patients were retreated. Conclusions: In the treatment of the urethral syndrome the few reports on attempts to restore a normal urothelium by means of diathermocoagulation and cryotherapy have been encouraging. Sidefi ring laser, which produces necrotic coagulation followed by reconstitution of normal functional epithelium, was signifi cantly more successful than end-fi ring and was associated with a 78% success rate. These results are encouraging in patients who are usually refractory to medical therapy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
