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Clinical Question:
Does cyclooxygenase-2 inhibitor (Celecoxib, Rofecoxib) prevent urethral
strictures in post-TURP patients?
Bottom Line:
Postoperative treatment with a COX-2 inhibitor can effectively prevent post-TURP
urethral stricture development by specifically interfering with the
inflammatory processes that can precede scar formation.
Reference:
Use of cyclooxygenase-2 inhibitor for prevention of urethral strictures
secondary to transurethral resection of the prostate.Sciarra A, Salciccia S,
Albanesi L, Cardi A, D'Eramo G, Di Silverio F. Urology. 2005
Dec;66(6):1218-22.
Study Design:
Prospective, unblinded, randomized, single-center study
Synopsis:
To analyze whether the addition of a cyclooxygenase (COX)-2 inhibitor after
transurethral resection of the prostate (TURP) offers an advantage compared
with TURP alone in reducing postoperative urethral strictures. At
urethroscopy, stenosis of the urethra with a circumference of less than 19
mm was defined as stricture. This was a prospective, unblinded, randomized,
single-center study. Between December 2001 and December 2003, 96 consecutive
men with benign prostatic hyperplasia underwent TURP. After TURP, patients
were randomly assigned to receive or not receive a COX-2 inhibitor (rofecoxib
25 mg/day). In the group given the COX-2 inhibitor, the therapy was started
at catheter removal and continued for 20 days. Follow-up was performed on an
outpatient basis after 1 month. A diagnosis of postoperative urethral
stricture was assessed during a follow-up of 12 months. At the 1-month
visit, the mean and median improvement in the peak urinary flow rate from
preoperative values was +6.25 +/- 3.76 mL/s (median 7.30) in the no COX-2
inhibitor group and +9.42 +/- 3.06 mL/s (median 8.75) in the COX-2 inhibitor
group. The improvement was significantly (P < 0.0001) greater for the group
treated with the COX-2 inhibitor. At 1 year of follow-up, a urethral
stricture had been diagnosed in 8.3% of all cases; in particular, in 17% and
0% of cases in the no COX inhibitor group and COX-2 inhibitor group,
respectively. Post-TURP COX-2 inhibitor therapy was significantly (P =
0.0039) and inversely (r = -0.2876) associated with urethral stricture
development. |