Impact of Prior Paclitaxel-Coated Balloon Dilation on Urethroplasty Complexity and Histopathology: Initial Experience in a Comparative Case Series

Abstract

Aims: This case series describes surgical complexity and histopathological findings during urethroplasty for recurrent short bulbar strictures following failed drug-coated balloon (DCB) dilation, compared with those in DCB-naïve cases. Methods: We conducted a preliminary comparative study including six adult patients who underwent urethroplasty for short (<3 cm) bulbar strictures at a single referral centre. Three patients had previously undergone failed paclitaxel-coated balloon dilation, while three patients underwent urethroplasty without prior DCB exposure. Operative complexity was assessed using subjective surgeon assessment and the validated Surgery Task Load Index (SURG-TLX). Perioperative outcomes were recorded, and excised stricture specimens underwent blinded histopathological analysis. Results: Urethroplasty techniques included non-transecting excision and primary anastomosis and, in one case, augmented urethroplasty with a buccal mucosa graft. Operative time, length of hospital stay (≤24 hours), duration of urethral catheterisation (20–22 days), and perioperative outcomes were similar on an individual-case basis. Surgeons’ subjective workload assessments demonstrated overlapping SURG-TLX scores across cases, with no obvious increase in perceived surgical difficulty in patients previously treated with drug-coated balloon dilation. Histopathological examination revealed chronic inflammation and non-specific stromal fibrosis in all specimens, with no overt morphological differences on routine staining attributable to prior paclitaxel exposure. Conclusions: In this small, exploratory experience, prior paclitaxel-coated balloon dilation was not associated with overt increases in perceived surgical complexity or routine histopathological abnormalities at the time of subsequent urethroplasty for short bulbar urethral strictures. These findings are hypothesis-generating and should be interpreted cautiously, pending confirmation in larger, methodologically robust studies.