Original article / research
Effect of Tadalafil on Prevention of Urethral Stricture after Direct Vision Internal Urethrotomy: A Prospective Cohort Study
Correspondence Address :
Dr. Shyam Sundar Sarkar,
A2/4, Orchid Residency, Pradhan Nagar, Siliguri, West Bengal, India.
E-mail: rex014sss@gmail.com
Introduction: Urethral stricture recurrence following Direct Vision Internal Urethrotomy (DVIU) remains a significant challenge. Phosphodiesterase type-5 inhibitors (PDE5-Is), such as tadalafil, have been proposed to reduce fibrosis and stricture recurrence by enhancing vascularity and inhibiting inflammation.
Aim: To evaluate the efficacy of tadalafil in preventing stricture recurrence after DVIU.
Materials and Methods: This prospective cohort study was conducted at the Department of Urology, IPGME&R, Kolkata, West Bengal, India, from March 2024 to February 2025. A total of 150 male patients with primary short anterior urethral strictures (<1 cm) were enrolled. Patients were divided into two groups: tadalafil group (n=81) and non tadalafil group (n=69). The exclusion criteria included recurrent or long strictures, congenital anomalies, cardiopulmonary compromise, and bleeding disorders. DVIU was performed under sedation and anaesthesia. Outcomes assessed were the need for further surgical intervention and peak urinary flow rate (Qmax) at three-month follow-up. Statistical analyses used was Chi-square test for categorical variables and Welch’s t-test for continuous variables; p-value <0.05 was considered statistically significant.
Results: Baseline demographics were comparable. Further surgical intervention was significantly lower in the tadalafil group (18.5%) compared with the control group (33.3%; p-value=0.046). The mean Qmax was significantly higher in the tadalafil group (10.5±2.4 mL/s) than in the control group (9.1±2.8 mL/s; p-value=0.032). Kaplan-Meier analysis showed higher stricture-free survival in the tadalafil group (p-value=0.041).
Conclusion: Tadalafil significantly reduces stricture recurrence and improves urinary flow after DVIU. Larger, long-term multicentre studies are needed to validate these findings and to integrate tadalafil into routine DVIU protocols.
Fibrosis, Follow-up studies, Phosphodiesterase 5 inhibitors, Treatment outcome, Urethrotomy
DOI: 10.7860/JCDR/2025/79781.22025
Date of Submission: Apr 07, 2025
Date of Peer Review: Jun 12, 2025
Date of Acceptance: Aug 28, 2025
Date of Publishing: Nov 01, 2025
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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ETYMOLOGY: Author Origin
EMENDATIONS: 8
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