Table 4. Previous studies evaluated Holmium and cold knife VIU.
| Study | Type of studies | Number of patients | Arms of the study | Primary end point | Secondary end point | Success rate | complication | limitation |
| Dogra et al. 2002 | Retrospective cohort | 61 | Singles (Holmium VIU) | Improved Qmax at 3 months > 15 ml/sec. |
Operative time Durable success rate till 30 months |
96 % | Recurrence of stricture in 2 cases |
-Lack of comparative arm -Retrospective nature of the study |
|
Singh et al. 2014 |
Randomized controlled trial | 90 | Cold knife versus VIU | Improved Qmax at 3 months > 15 ml/sec |
Operative time Postoperative complication |
100% | Overall, 13.3% including urethral bleeding, postoperative pain, UTI, and recurrence in 6 cases | -Short duration of follow up. |
| Holmium VIU | 86.7 % | |||||||
| Atak et al. 2011 | Randomized controlled trial | 30 patients | cold knife VIU | Improved Qmax > 15 ml/sec | Durability regarding restenosis | 81% | No reported complication | Heterogenous etiology and site of stricture |
| 21 patients | holmium VIU | 53 % | ||||||
|
Dutkiewicz et al. 2011 |
Prospective clinical trial | 50 patients | Cold knife VIU | Improved Qmax |
Post voiding residual Quality of life |
The results obtained did not confirm a superiority based on Qmax improvement and QoL of one technique over the other at 1-year follow-up. | No reported complications | No assessment for success rate and restenosis in the study |
| Holmium VIU | ||||||||
|
Aboulela et al. 2018 |
Prospective clinical trial for holmium VIU compared to a historical control of cold knife VIU | 42 | Cold knife VIU | Improved Qmax at 3 months > 15 ml/sec | Post-operative morbidity | 47.6% | No reported complications |
-Short follow up -Retrospective analysis -Non randomization -Heterogenous etiology and site of stricture |
| Holmium VIU | 76.2% | |||||||
|
Yenice et al. 2018 |
Randomized controlled trial | 29 patients | Cold knife VIU | Improved Qmax |
Recurrence rate Complications |
79.3% |
3 cases of urethral bleeding in cold knife group 1 case of extravasation in holmium group |
Small sample size |
| 34 patients | Holmium VIU | 67.3% | ||||||
|
Karkan et al. 2019 |
Prospective single arm clinical trial | 138 | Holmium VIU | Improved Qmax |
Recurrence rate Complications |
73.2% |
24 cases of intraoperative hematuria 9 cases of penile burning sensation |
Lack of comparative group |
VIU: Visualized internal urethrotomy, Qmax: maximum flow rate