To the Editor:
We thank you for your interest and your kind reception of our work. Hyaluronic acid/carboxymethylcellulose (HA/CMC) has been used in surgical procedures to prevent postoperative adhesions.
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Maintaining HA/CMC in the urethral lumen was the most difficult task in this study, however. We carefully considered this problem before commencing the clinical trial. As you commented, an improved method to maintain HA/CMC in the urethral lumen would increase the effectiveness of HA/CMC. According to Chung and associates,
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HA/CMC instillation after transurethral resection of the prostate using the same method decreases the incidence of urethral stricture, however.
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Otherwise, in our experience, repeated instillation of HA/CMC divided over a single day with moderate traction can be an alternative method.
Regretfully, the length of the urethral stricture was only measured by the urologic surgeon. As you commented, measurement of the urethral stricture length by a blinded radiologist would be more reliable. The recurrence rate was evaluated not only by retrograde urethrography, but also by uroflowmetry, urethroscopy, and consideration of patients' symptoms, however. A double-blind evaluation is needed.
As we stated, a limitation of this study is that the follow-up period was relatively short. We have been enrolling patients in this trial continuously, however. In accordance with your comments, we plan to publish the long-term follow-up data.
