Drug-Coated Balloon Therapy (Optilume)
The Optilume® paclitaxel-coated balloon is the cross-cutting drug-coated-balloon technology used for both bulbar urethral stricture (ROBUST III pivotal RCT) and the investigational ureteral stricture indication (ENDURE-1).
The canonical WARWIKI page lives in the cross-cutting Treatment Atlas: Drug-Coated Balloon Therapy. This urethral-reconstruction page is a pointer plus a short selection summary so readers landing from the urethral database do not hit a dead end.
For related urethral options, see DVIU and Urethral Dilation and Endoscopic Urethroplasty (Suturing Device). For the ureteral endoscopic counterpart, see Endoureterotomy.
Urethral Selection Snapshot
| Best supported | Less certain / off-label |
|---|---|
| Recurrent bulbar stricture less than 3 cm after prior dilation or DVIU | Penile urethral strictures |
| Patient wants an endoscopic bridge before urethroplasty | Posterior urethral stenosis, BNC, or VUAS |
| Patient understands this is not urethroplasty-equivalent durability | Treatment-naive strictures outside trials |
Technique Snapshot
The operative concept is mechanical dilation plus local paclitaxel delivery. The working sequence is: confirm stricture length and location endoscopically, obtain wire access, pre-dilate enough to deploy the balloon, center the drug-coated segment across the scar, inflate per device protocol, drain briefly with catheter, and follow with symptom score, uroflow, PVR, and cystoscopy when recurrence is suspected.
Counseling Snapshot
Drug-coated balloon therapy is a better endoscopic option for selected recurrent bulbar strictures, not a replacement for substitution urethroplasty. A DCB failure should trigger reassessment of stricture length, spongiofibrosis, radiation history, lichen sclerosus, and candidacy for definitive reconstruction rather than automatic serial repeat dilation.