Effect of Tadalafil on Prevention of Urethral Stricture after Direct Vision Internal Urethrotomy: A Prospective Cohort Study
Year: 2025
Type: article
Abstract: 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 stricturefree 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.
Authors: Shyam Sundar Sarkar, Soumya Mondal, Debansu Sarkar
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $275
OpenAlex ID: W4415210634
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