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Urology
Original research
Balloon dilation for the treatment of male urethral strictures: a systematic review and meta-analysis
  1. Xiaoyu Li1,2,
  2. Chunru Xu1,2,
  3. Xing Ji1,2,
  4. Zhenpeng Zhu1,2,
  5. Tianyu Cai1,2,
  6. Zhenke Guo1,2,
  7. Jian Lin1,2
  1. 1Department of Urology, Peking University First Hospital, Beijing, China
  2. 2Institute of Urology, Peking University, Beijing, China
  1. Correspondence to Professor Jian Lin; linjianbj{at}163.com

Abstract

Objective The use of minimally invasive endoluminal treatment for urethral strictures has been a subject for debate for several decades. The aim of this study was to review and discuss the safety, efficacy and factors influencing the clinical application of balloon dilation for the treatment of male urethral strictures.

Design Systematic review and meta-analysis.

Data sources Embase, Medline, Web of Science, Cochrane Library and Scopus were searched for publications published before 17 July 2022.

Study selection Two independent researchers screened and assessed the results, and all clinical studies on balloon dilation for the treatment of urethral strictures in men were included.

Data extraction and synthesis The success rate, rate of adverse events, International Prostate Symptom Scores, maximum uroflow (Qmax) and postvoid residual urine volume were the main outcomes. Stata V.14.0 was used for statistical analysis.

Results Fifteen studies with 715 patients were ultimately included in this systematic review. The pooled results of eight studies showed that the reported success rate of simple balloon dilation for male urethral strictures was 67.07% (95% confidence interval [CI]: 55.92% to 77.36%). The maximum urinary flow rate at 3 months (risk ratio [RR]= 2.6510, 95% CI: 1.0681 to 4.2338, p<0.01) and the maximum urinary flow rate at 1 year (RR= 1.6637, 95% CI: 1.1837 to 2.1437, p<0.05) were significantly different after dilation. There is insufficient evidence to suggest that balloon dilation is superior to optical internal urethrotomy or direct visual internal urethrotomy (DVIU) (RR= 1.4754, 95% CI: 0.7306 to 2.9793, p=0.278).

Conclusion Balloon dilation may be an intermediate step before urethroplasty and is a promising alternative therapy to simple dilation and DVIU. The balloon is a promising drug delivery tool, and paclitaxel drug-coated balloon dilation is effective in reducing retreatment rates in patients with recurrent anterior urethral strictures. The aetiology, location, length, previous treatment of urethral stricture may be associated with the efficacy of balloon dilation.

PROSPERO registration number CRD42022334403.

  • UROLOGY
  • Adult urology
  • Kidney & urinary tract disorders

Data availability statement

Data are available on reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2023-071923

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    Data availability statement

    Data are available on reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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    Footnotes

    • Contributors Conceptualisation was created by XL and CX. Investigation was performed by XL, XJ and CX. Analysis and interpretation of data were produced by XL, XJ and CX. XL and CX wrote the manuscript. XL and XJ conducted the statistical analysis. Critical revision of the manuscript for important intellectual content was produced by XL, CX, ZZ, TC, ZG and JL. Supervision was performed by JL.

      XL and JL act as guarantors for this study.

    • Funding This work was financially supported by the National Natural Science Foundation of China (Grant No. 8207032402).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.