Drug-coated balloon (DCB) dilatation with paclitaxel shows higher patency rates and freedom from reintervention compared to standard dilation or DVIU.
ROBUST III trial demonstrated 75% patency at 6 months and 83% freedom from reintervention at 1 year with DCB.
DCB offers a minimally invasive alternative to urethroplasty with durable long-term efficacy and low adverse events.
Guideline-Based Recommendations
Diagnosis
Identify male patients with anterior urethral strictures causing urinary obstruction.
Assess stricture length (<3 cm) and history of prior failed endoscopic treatments.
Management
Consider drug-coated balloon dilatation as a minimally invasive treatment option for eligible patients.
Use paclitaxel-coated balloon devices (e.g., Optilume®) to inhibit fibroblast proliferation and reduce recurrence.
Reserve urethroplasty for cases requiring durable reconstruction or when DCB is contraindicated or unsuccessful.
Monitoring & Follow-up
Evaluate anatomic patency at 6 months post-procedure.
Monitor symptom relief using IPSS and urinary flow rates (Qmax).
Assess post-void residual volume (PVR) and watch for recurrence or need for reintervention.
Risks
Low incidence of serious adverse events reported with DCB use.
Potential for stricture recurrence requiring repeat intervention.
Patient & Prescribing Data
Men with short anterior urethral strictures and multiple prior failed endoscopic treatments
DCB dilatation provides improved patency and symptom relief compared to standard dilation or DVIU, with durable outcomes up to 5 years and minimal serious adverse events.
Clinical Best Practices
Select patients carefully based on stricture characteristics and prior treatment history.
Employ standardized procedural techniques for DCB deployment to optimize outcomes.
Provide peri-operative management and post-treatment counseling tailored to DCB use.
Utilize validated symptom and flow metrics for follow-up assessments.
Engage in multidisciplinary discussions and consider patient preferences when choosing between DCB and urethroplasty.
by Diarmuid D. Sugrue, John O’Connor, Łukasz Białek, Francesco Chierigo, Mikołaj Frankiewicz, François Xavier Madec, Behzad Abbasi, Leonidas Karapanos, Jakob Klemm, Mattia Lo Re, Juan Diego Tinajero, Jordán Scherñuk, Guglielmo Mantica, Paul Neuville, Maciej Oszczudłowski, Wesley Verla, Malte W. Vetterlein, Niall F Davis, Felix Campos-Juanatey, Elaine J. Redmond
