Optilume as a new treatment for urethral stricture
What is a urethral stricture?
A urethral stricture is a scarred narrowing in the urethra. It is most commonly caused by infections and direct injuries (for example from previous urological procedures). This scarring leads to problems with urination (weakened urinary stream, straining to void, residual urine) up to the inability to empty the bladder completely or partially.
Increased urinary urgency or frequent nighttime urination can also occur. Living with a urethral stricture can significantly restrict everyday life and impair quality of life (2). If left untreated, a urethral stricture can lead to infections, bladder and kidney damage, or infertility.
Optilume is a new treatment option for urethral stricture
Treating a urethral stricture with an alternative approach is possible with Optilume technology via a small intervention. It is a minimally invasive, fast, and gentle method compared to urethral surgeries such as urethroplasty using buccal mucosa or Mucocell (urethroplasties), or even internal urethrotomy. CUROS, your urology center in the Cologne/Bonn area, offers the innovative Optilume method as one of very few practices in all of Europe (as of May 2023).
Effective treatment with the Optilume method provides immediate relief of symptoms. In addition, it achieves a lasting cure of the stricture in more than three quarters of treated patients.
This is what the inflated Optilume balloon coated with paclitaxel looks like.
How is the alternative Optilume treatment for urethral stricture performed?
The Optilume procedure is performed on an outpatient basis, with short anesthesia if desired. The surgeon inserts a small, elongated balloon coated with a medication into the patient’s urethra. It is positioned at the site of the stricture and gently inflated to dilate the narrowing.
At the same time, paclitaxel—the medication on the balloon surface—helps prevent new scar formation (1). Including preparation and follow-up, the entire treatment takes only about half an hour.
Paclitaxel is a proven antiproliferative medication that has been used in chemotherapy since the early 1990s. Its mechanism of action as a mitosis inhibitor consists of stabilizing microtubules to prevent the transition from metaphase to anaphase, thereby inhibiting cell division and migration as well as the growth of new tissue and fibrotic scarring that would lead to recurrence of the stricture.
The schematic sequence of a urethral Optilume procedure.
What evidence exists for Optilume treatment?
A study demonstrates a high success rate: compared with conventional procedures, 80 percent of patients treated with Optilume had no recurrent urethral stricture one year after the intervention, in contrast to the control group. In that group, all patients treated with previous methods experienced recurrence after one year (7).
Even three years after Optilume treatment, current literature documents the absence of recurrence in 77 percent of cases and a sustained improvement in urinary flow (6).
Who is eligible for treatment with the new Optilume method?
- For patients with a first-time urethral stricture.
- For patients with a previously treated stricture that has recurred.
- For patients who want a minimally invasive procedure with immediate symptom relief.
- For patients who decline anesthesia or for whom anesthesia is not possible.
Photo shows a procedure performed with the Optilume method.
Will my health insurance cover the Optilume procedure?
Private health insurers usually cover the costs of the procedure. Statutory health insurance unfortunately does not cover the costs at this time.
Video on Optilumewith PD Dr. med. Timur Kuru
References
Virasoro, R., J. Delong, R. Estrella, M. Pichardo, R. Rodriguez, G. Espino and S. P. Elliott (2021). „The Optilume® drug coated balloon for recurrent anterior urethral strictures: 3-year results for the ROBUST I study.“ European Urology 79: S555
Urologielehrbuch.de
Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H: Urethral strictures—etiology, investigation and treatments. Dtsch Arztebl Int 2013; 110(13): 220–6. DOI: 10.3238/arztebl.2013.0220
Heyns CF et al: Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J
Urol 1998 Aug;160(2):356-8. doi: 10.1016/s0022-5347(01)62894-5
Barbagli G, De Angelis M, Romano G, Lazzeri M: Long-term follow up of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol 2007; 178: 2470–3
Virasoro, R., J. Delong, R. Estrella, M. Pichardo, R. Rodriguez, G. Espino and S. P. Elliott (2021). „The Optilume® drug coated balloon for recurrent anterior urethral strictures: 3-year results for the ROBUST I study.“ European
Urology 79: S555
Elliott, S. P., K. Coutinho, K. J. Robertson, R. D’Anna, K. Chevli, S. Carrier, M. Aube-Peterkin, C. H. Cantrill, M. J. Ehlert, A. E. Te, J. Dann, J. M. DeLong, S. B. Brandes, J. C. Hagedorn, R. Levin, A. Schlaifer, E. DeSouza, D. Di-Marco, B. A. Erickson, R. Natale, D. A. Husmann, A. Morey, C. Olsson and R. Virasoro (2021). „One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume® Drug-Coated Balloon for Anterior Urethral Strictures.“ J Urol: 101097JU0000000000002346.