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Intralesional Corticosteroids

Intralesional corticosteroids (primarily triamcinolone acetonide) are used across urology as anti-inflammatory and anti-fibrotic adjuncts rather than stand-alone therapies. The most guideline-supported indications are submucosal injection for Hunner lesions in IC/BPS [3]; stricture or BNC injections have more uncertain, largely off-label evidence. Reported applications include refractory hyperkeratotic genital lichen sclerosus in selected adult women[34], localized dermal lichen planus[38], BXO at preputioplasty[26], post-RP vesicourethral anastomotic stenosis[14], and benign ureteroenteric anastomotic strictures[27].

For related agents, see High-potency topical corticosteroids, Topical calcineurin inhibitors, Antimitotics / antifibrotics (mitomycin C), Platelet-rich plasma, and Intravesical IC/BPS agents.

Mechanism in urologic fibrotic and inflammatory disease​

Triamcinolone acetonide acts through:[4][5]

  • Anti-inflammatory. Phospholipase-A2 inhibition leading to reduced prostaglandins and leukotrienes; decreased capillary permeability and leukocyte migration
  • Anti-fibrotic. Suppression of fibroblast proliferation and collagen synthesis; reduced MMP-3 and TGF-β expression in treated bladder-neck tissue[6]
  • Local immunomodulation. Systemic absorption and effects remain possible, especially as total injected volume increases.[38]

Published urologic protocols often use triamcinolone acetonide suspension. Formulations and routes are not interchangeable: the US Kenalog-40/80 label is for intramuscular or intra-articular use only and lists intradermal, intravenous, intraocular, epidural and intrathecal use as not permitted.[5] Kenalog-10 (10 mg/mL) is the US product labeled for intralesional use, and its label lists selected dermatoses such as keloids, lichen planus, lichen simplex chronicus, alopecia areata and psoriatic plaques; it is not labeled for intramuscular use, and the label warns of cutaneous atrophy at the injection site.[38] Urethral and bladder-wall injections, and penile or preputial injections for LS/BXO, are off-label under either label and require a site-specific protocol and pharmacy verification; Kenalog-10 separately lists localized dermal lichen-planus lesions among its labeled intralesional indications.[38]

IC/BPS — Hunner lesions (AUA-recommended)​

AUA IC/BPS guideline 2022, Statement 19 (Recommendation; Grade C): if Hunner lesions are present, fulguration (with laser or electrocautery) and/or injection of triamcinolone should be performed. The guideline advises counseling that retreatment is likely when symptoms recur, and notes that most Hunner lesions can be identified at office cystoscopy (Statement 4). The evidence is observational: primarily fulguration/electrocautery series reported mean response durations of about 2 to 22 months, while one submucosal triamcinolone series reported an average improvement duration of 7–12 months.[3]

The 2025 Canadian Urological Association guideline conditionally recommends fulguration, intralesional triamcinolone, or intradetrusor onabotulinumtoxin A with or without hydrodistension for Hunner-lesion IC/BPS (very low certainty); sparse direct comparisons prevent ranking these options.[39]

Technique​

The 2025 CUA guideline advises biopsy of Hunner lesions to exclude malignancy.[39] Endoscopic submucosal injection of triamcinolone directly into and around Hunner lesions under cystoscopic guidance.[7]

Efficacy​

StudynFinding
Funaro 201836Pain score 8.3 → 3.8 at about 1 month (p < 0.001); 72% needed only one set of injections, and the mean interval to repeat injection in the rest was about 345 days (retrospective)[7]
Mateu 201720VAS 8 → 2.5 (p < 0.001) after flexible-cystoscope injection; retrospective, median follow-up 7 months; 7 of 10 patients followed at least 8 months needed retreatment[8]

Retrospective Hunner-lesion injection series report improvement after one procedure for some patients, but response duration varies and retreatment is common with longer follow-up.[3][7][8] See Intravesical IC/BPS agents for the broader instillation and injection framework.

Urethral stricture — adjunct to internal urethrotomy​

Intralesional corticosteroid is one of the most-studied adjuncts to internal urethrotomy (IU) / urethral dilation.

Meta-analytic evidence​

  • Pang 2021 reviewed 26 studies of adjuncts to minimally invasive stricture treatment. Its meta-analysis of 13 RCTs (859 men) found lower recurrence with an adjunct than with no adjunct (OR 0.37; 95% CI 0.27–0.50; p < 0.001). Mitomycin C had the strongest signal in indirect pooled comparisons (intralesional OR 0.23; 95% CI 0.11–0.48).[9]
  • Zhang 2014 meta-analysis (8 RCTs; 203 steroid-treated patients): local steroids plus IU prolonged time to recurrence (mean 10.14 versus 5.07 months; p < 0.001), but did not significantly change the overall recurrence rate or the success of second urethrotomy[10]
  • Soliman 2022 meta-analysis (7 RCTs, n = 365; injected or topical urethral steroid after DVIU): lower recurrence (RR 0.67; 95% CI 0.49–0.90) and longer time to recurrence (HR 0.58; 95% CI 0.39–0.85), with no significant Qmax gain. Certainty was downgraded for small trials and unclear bias.[35]
  • Andhika 2025 meta-analysis (6 RCTs, 373 men): triamcinolone ointment with clean intermittent catheterization was associated with lower recurrence (OR 0.47; 95% CI 0.26–0.82), while the two submucosal-injection trials did not show a significant recurrence reduction.[41]
  • Korrapati 2026 RCT (50 men with primary inflammatory bulbar strictures <2 cm): 40 mg intralesional triamcinolone at urethrotomy yielded Qmax 1.52 mL/s higher than urethrotomy alone one month after catheter removal (primary endpoint); eight-month recurrence was 3/25 versus 10/25 (Fisher p = 0.051).[42]
  • Jacobs 2021 systematic review: the positive clinical effect of steroids appears to decrease with longer follow-up, suggesting a time-limited anti-fibrotic benefit[11]
  • AUA 2023 amendment: surgeons may inject pharmacologic agents into the stricture at DVIU; steroid studies showed a consistently lower recurrence rate that did not reach statistical significance, with short follow-up. This is a permissive statement, not a recommendation for a specific agent[36]

Technique​

Triamcinolone acetonide was used intralesionally in a 96-patient urethral-stricture series.[12] The cited 40 mg/mL, eight-point injection with a postoperative series was described for highly recurrent post-TURP bladder-neck contracture.[13] The original Sharpe-Finney 1976 series (n = 96) established the technique and noted particular utility for distal or meatal strictures and post-RP anastomotic strictures.[12]

EAU 2026: the summary of evidence rates injections after DVIU as possibly improving short-term stricture-free rates (LE 1a) but notes that drug, dose, volume and technique are uncertain and use is off-label. The recommendation is to use intralesional injections only within clinical trials. Agent comparison: current EAU guidance limits intralesional post-DVIU injections to clinical trials; there is no established default MMC-versus-steroid sequence.[31] See Antimitotics / antifibrotics.[9]

Intraurethral steroid with self-dilatation: a separate strategy from injection. In an EAU panel meta-analysis of five RCTs (n = 250), adding topical triamcinolone ointment to ISD after DVIU raised stabilisation during 6–36 months of follow-up (77% versus 64%) with no extra complications reported, though bias risk was unclear to high.[37] EAU 2026 gives a weak recommendation to use intraurethral corticosteroids in addition to ISD.[31][37]

Bladder-neck contracture and post-RP VUAS​

BNC after TURP or open prostatectomy and VUAS after radical prostatectomy both carry high recurrence rates after endoscopic treatment alone.

Post-TURP BNC​

  • Zhang 2021. In 28 patients with highly recurrent post-TURP BNC (mean prior recurrence interval 2.2 months), resection plus intra- and postoperative triamcinolone (40 mg/mL at eight points, then every four weeks for three postoperative injections) yielded author-reported 92.9% success; 25/28 had adequate voiding at median 2.8-year follow-up. These are distinct reported endpoints.[13]

  • Sun 2022. 180-W GreenLight laser vaporization with repeated triamcinolone injections (n = 46): zero recurrence during follow-up; significant improvement in Qmax, IPSS, QoL, PVR. Immunohistochemistry showed reduced collagen I, MMP-3, and TGF-β in treated tissue[6]

  • Palminteri–Ferrari 2024. In an uncontrolled series of 45 patients with mixed-cause bladder-neck stenosis, four-quadrant holmium incisions plus 40 mg triamcinolone required repeat treatment in 24/45 (53.3%) at the scheduled two-month endoscopy; 4/45 (8.9%) required diversion and 2/45 (4.5%) required incontinence surgery at median 18-month follow-up.[16] EAU 2026 strongly recommends against deep 6- or 12-o'clock DVIU incisions for VUAS or radiation-induced bulbomembranous stricture because of rectal-injury and urosymphyseal-fistula risk.[31]

Post-RP VUAS​

For nonobliterative VUAS, EAU 2026 recommends warning patients about new or worsened incontinence after endoluminal treatment . It recommends against deep 6- or 12-o'clock incisions and against endoluminal treatment of complete obliteration .[31]

  • Eltahawy 2008. In a 24-patient post-RP series, holmium laser incisions at 3 and 9 o'clock with triamcinolone injection at the incision sites left 19 patients with a widely patent bladder neck after one or two procedures at mean 24-month follow-up.[14]
  • Kravchick 2013. In a retrospective comparison of 29 men with recurrent or resistant post-RP VUAS, dilation plus TRUS-guided steroid injection (n = 14) had the highest reported efficiency quotient, lower retreatment than cold-knife urethrotomy, and no new incontinence. TUR (n = 7) required no retreatment but had a 57.1% incontinence rate.[15]

A 2024 systematic review pooled seven previously treated VUAS cohorts receiving endoscopic treatment with a scar modulator: success defined as no secondary procedure was 62.2% (95% CI 47.6–74.9%; five triamcinolone studies and two mitomycin C studies).[40]

Peyronie's disease — not recommended​

Intralesional corticosteroids have a long history in Peyronie's disease, but the EAU 2026 guideline does not discuss them because the available evidence is poor and shows no significant effect.[33]

  • AUA PD guideline 2015. Intralesional dexamethasone and betamethasone with hyaluronidase and lidocaine appear only among "Other Treatments" (observational studies, small samples, no control for natural history); the AUA judged them unproven, with insufficient evidence for even a Conditional Recommendation, and made no statement for or against them[17][4]
  • Rosenberg 2023 Cochrane review. Very low certainty evidence for intralesional betamethasone versus saline; the effect on patient-reported change in penile curvature at long-term follow-up is uncertain (RR 0.75; 95% CI 0.20–2.79; one study, n = 30).[18]
  • Manfredi 2025 SR on acute-phase PD injection therapy: corticosteroids showed variable efficacy with favorable safety, but overall evidence quality is low[19]
  • Ure 2021 non-randomized methylprednisolone 40 mg weekly × 8 weeks (n = 48 acute-phase): significant reductions in plaque size (13.6 to 10.8 mm; p = 0.025) and PDQ scores; no AEs[20]

Why not preferred​

  • Risk of tunical atrophy and local tissue thinning with repeated injection
  • Potential worsening of erectile function
  • Other agents have differing guideline support: CCH has randomized evidence, whereas EAU finds insufficient support for intralesional verapamil.[33] There is no uniform all-society endorsement of every injection.[18][21][22][33]

See Peyronie's disease agents for the broader PD intralesional comparison.

Genital lichen sclerosus and lichen planus​

Intralesional corticosteroids are a selected specialist option for refractory hyperkeratotic genital LS in adult women after neoplasia is excluded; the German S3 guideline strongly recommends against them in girls with genital LS.[34] The German S3 guideline gives an open recommendation. Biopsy a resistant hyperkeratotic plaque to exclude neoplasia before injection. Concentration, volume, depth and interval depend on the lesion and formulation, with no validated 40-mg vulvar safety ceiling.[2][23][34]

Intraurethral clobetasol for penile / urethral LS​

  • Potts 2016. Intraurethral clobetasol applied with a catheter or dilator: 89% (25/28) had no escalation of therapy in a selected observational series at mean 24.8-month follow-up.[24] Most responders continued treatment.[24]
  • Hayden 2020. In 42 men with biopsy-proven LS-related urethral stricture, topical and intraurethral clobetasol was associated with median AUASS improving from 12 to 8 and QoL bother from 4 to 2; 85.7% (36/42) did not require surgery at median 8.4-month follow-up[25]

BXO in children — Wilkinson 2012​

In a retrospective comparison of boys with histologically confirmed BXO, 84/104 (81%) had a fully retractile foreskin without macroscopic BXO after preputioplasty plus intralesional triamcinolone, while 14/104 (13%) needed repeat preputioplasty or circumcision; meatal stenosis occurred in 6/104 (6%) versus 6/32 (19%) after primary circumcision at median 14-month follow-up.[26] See High-potency topical corticosteroids for the first-line topical framework in LS.[34]

Ureteroenteric anastomotic strictures​

Triamcinolone has been incorporated into endoscopic management of benign UEAS after urinary diversion. In a 2026 review of 31 studies (858 adults), open revision had higher primary patency than endoscopic treatment in seven comparative cohorts (368 renal units; RR 2.31; 95% CI 1.54–3.47), while pooled success was 58% in both laser and nonlaser endoscopic groups with varying endpoint definitions.[43]

  • Katims 2021. In 21 patients with 24 presumed benign UEAS, antegrade ureteroscopy with biopsy preceded laser incision, triamcinolone injection, and 24F balloon dilation. Stents or nephrostomy drainage remained for six weeks, followed by imaging surveillance; 20/24 strictures (83.3%) had no recurrence at median 30-month follow-up.[27]
  • Meretyk 1992. In a 13-patient benign ureteral-stricture series, five received triamcinolone into the stricture bed after endoureterotomy and dilation; the authors suggested improved patency.[28]

Idiopathic bulbar urethritis​

Ashraf 2017 pilot (n = 14 boys with idiopathic bulbar urethritis: hematuria with or without dysuria, without infection): cystoscopy-guided instillation of 40 mg triamcinolone with 85.7% complete or partial resolution, though 50% required at least one additional treatment.[29] In a separate retrospective cohort of 30 boys, complete symptom resolution occurred in 12/21 after steroid instillation (mean follow-up 22 months) and spontaneously in 6/9 observed boys (mean follow-up 82 months); long-term symptom-free survival did not differ significantly.[44]

Published dosing examples — not a universal protocol​

The studies below use heterogeneous schedules; verify total exposure, dilution, route, excipients and site-specific technique.

IndicationTypical doseTechniqueFrequency
Hunner lesions (IC/BPS)Study-specific submucosal dose; no standard regimenEndoscopic submucosal injection into / around lesionsSingle session; retreat PRN (Mateu: pain recurrence leading to retreatment after about 4 months in 5/20; Funaro: mean 345 days between sets among the 10/36 receiving repeat injections)[3][7][8]
Urethral strictureNo single typical dose (5–320 mg across reviewed injection studies)Intralesional injection; technique variedStudy-specific use with minimally invasive stricture treatment or in an earlier injection series[9][12]
Post-TURP BNC (Zhang 2021)80 mg (2 mL of 40 mg/mL) at eight pointsCystoscopic injection at resection sitesIntraoperative, then every four weeks for three postoperative injections[13]
BNC after TURP or PVP (Sun 2022)—Triamcinolone with 180-W GreenLight vaporizationIntraoperative, then weekly for three postoperative injections[6]
Post-RP VUAS; mixed-cause BNC seriesStudy-specific; 40 mg in the mixed-cause BNC seriesIncision plus injection for post-RP VUAS (Eltahawy), dilation plus TRUS-guided steroid (Kravchick), or incision plus injection for BNC (Palminteri–Ferrari)Eltahawy: reassessment at 6 weeks; Palminteri–Ferrari: 2-month endoscopic check and repeat treatment if needed[14][15][16]
Vulvar LSIndividualized concentration and total volumeSelected refractory plaques after excluding neoplasiaSpecialist-directed; no universal vulvar dose ceiling[23][34]
BXO — pediatricIntralesional at preputioplastyInjection into BXO-affected tissueAt time of preputioplasty[26]
Ureteroenteric strictureInto stricture bedAntegrade / ureteroscopic injectionAt laser incision[27]

Safety​

Small BNC series report mild complications.[6][13] Local tissue injury and systemic steroid effects remain possible with intralesional injection, and endoluminal treatment of VUAS can cause new or worsened incontinence.[31][34][38]

ConcernDetails
Acute local infectionDo not inject intralesional Kenalog-10 at an acutely infected site.[38]
UTI2.9–14% across small male urethral-stricture steroid-injection studies (high risk of bias)[9]
Bleeding after DVIU3/34 (8.8%) after triamcinolone versus 3/36 (8.3%) after sterile-water injection in one trial[9][45]
Extravasation after DVIU2/34 (5.8%) versus 2/36 (5.6%) in the same trial[9][45]
Iatrogenic Cushing's syndromeTwo pediatric cases reported after intralesional triamcinolone for urethral strictures[30]
Tissue atrophy or ulcerationLocal corticosteroid atrophy remains a risk, especially with repeated injection into thin genital skin.[5] In genital LS, avoid intralesional injections into atrophic skin or small lesions because tissue injury and ulceration can result; an experienced clinician should perform and monitor treatment.[34]
Systemic steroid effectsImpaired wound healing, hyperglycemia, adrenal suppression with repeated high doses, immunosuppression[5]

Evidence Summary​

IndicationEvidence levelKey source
IC/BPS Hunner lesionsGuideline Clemens 2022[3]; Funaro 2018[7]; Mateu 2017[8]
Urethral stricture adjunct (with DVIU)Meta-analyses of small RCTs; low certainty [31]Pang 2021[9]; Zhang 2014[10]; Jacobs 2021[11]
Bladder-neck contractureLevel 3 (retrospective)Zhang 2021: author-reported 92.9% success after resection plus serial injections[13]; Sun 2022: zero recurrence during follow-up in a 46-patient post-TURP/PVP series, with IHC correlate[6]
VUAS post-RPLevel 3Eltahawy 2008[14]; Kravchick 2013[15]
Peyronie's diseaseVery low (Cochrane)Rosenberg 2023[18]; AUA 2015[17]
Vulvar LS in adult women (refractory hyperkeratotic lesions)Selected specialist use; German S3 open recommendationS3 LS guideline[34]
Vulvovaginal LPSpecialist practice reported; injection efficacy unmeasuredCooper 2008 survey of vulvovaginal LP treatment practices[46]
Topical skin and catheter-applied intraurethral clobetasol for penile / urethral LSLevel 3 observational evidencePotts 2016[24]; Hayden 2020[25]
Pediatric BXO at preputioplastyLevel 3Wilkinson 2012[26]
Ureteroenteric stricturesLevel 3Katims 2021[27]

Clinical Positioning​

  • For Hunner lesions, triamcinolone injection may be used with or without fulguration. The AUA recommendation does not require the combination.[3]
  • Stricture adjuncts are not a routine MMC-first sequence. EAU limits intralesional post-DVIU agents to clinical trials.[31]
  • Do not generalize study injection or incision recipes across anatomy.[5][31]
  • Intralesional corticosteroids are not established Peyronie therapy. See the dedicated agent page for the different levels of support for CCH, interferon and verapamil.[17][18][21][22]
  • For topical-treatment-resistant hyperkeratotic genital LS in adults, exclude neoplasia before injection and use site-specific dosing; a vulvar review lists no more than 40 mg of triamcinolone acetonide across the entire vulva.[2][23][34]
  • Pediatric BXO preputioplasty evidence is limited.[1][26] EAU 2026 strongly recommends offering circumcision for BXO or treatment-refractory phimosis and counseling about meatal-stenosis risk; BXO warrants prolonged follow-up for meatal or urethral involvement.[32]
  • Cushing syndrome, adrenal suppression and tissue atrophy remain possible.[5][30]

See Also​

References​

1. Moreno G, Ramirez C, Corbalán J, et al. "Topical corticosteroids for treating phimosis in boys." Cochrane Database Syst Rev. 2024;1:CD008973. doi:10.1002/14651858.CD008973.pub3

2. American College of Obstetricians and Gynecologists. "Diagnosis and management of vulvar skin disorders: ACOG Practice Bulletin Summary, Number 224." Obstet Gynecol. 2020;136(1):222–225. doi:10.1097/AOG.0000000000003945

3. Clemens JQ, Erickson DR, Varela NP, Lai HH. "Diagnosis and treatment of interstitial cystitis/bladder pain syndrome." J Urol. 2022;208(1):34–42. doi:10.1097/JU.0000000000002756

4. Trost LW, Gur S, Hellstrom WJ. "Pharmacological management of Peyronie's disease." Drugs. 2007;67(4):527–545. doi:10.2165/00003495-200767040-00004

5. DailyMed. Kenalog-40/80 (triamcinolone acetonide injectable suspension) prescribing information, label effective August 2024. Label.

6. Sun X, Jin X, Leng K, Zhao Y, Zhang H. "180-W GreenLight laser photoselective vaporization with multiple triamcinolone acetonide injections for the treatment of bladder neck contractures." Lasers Med Sci. 2022;37(8):3115–3121. doi:10.1007/s10103-022-03568-2

7. Funaro MG, King AN, Stern JNH, Moldwin RM, Bahlani S. "Endoscopic injection of low dose triamcinolone: a simple, minimally invasive, and effective therapy for interstitial cystitis with Hunner lesions." Urology. 2018;118:25–29. doi:10.1016/j.urology.2018.03.037

8. Mateu L, Izquierdo L, Franco A, et al. "Pain relief after triamcinolone infiltration in patients with bladder pain syndrome with Hunner's ulcers." Int Urogynecol J. 2017;28(7):1027–1031. doi:10.1007/s00192-016-3213-3

9. Pang KH, Chapple CR, Chatters R, et al. "A systematic review and meta-analysis of adjuncts to minimally invasive treatment of urethral stricture in men." Eur Urol. 2021;80(4):467–479. doi:10.1016/j.eururo.2021.06.022

10. Zhang K, Qi E, Zhang Y, Sa Y, Fu Q. "Efficacy and safety of local steroids for urethra strictures: a systematic review and meta-analysis." J Endourol. 2014;28(8):962–968. doi:10.1089/end.2014.0090

11. Jacobs ME, de Kemp VF, Albersen M, de Kort LMO, de Graaf P. "The use of local therapy in preventing urethral strictures: a systematic review." PLoS One. 2021;16(10):e0258256. doi:10.1371/journal.pone.0258256

12. Sharpe JR, Finney RP. "Urethral strictures: treatment with intralesional steroids." J Urol. 1976;116(4):440–443. doi:10.1016/s0022-5347(17)58850-3

13. Zhang L, Liu S, Wu K, Mu X, Yang L. "Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections." World J Urol. 2021;39(2):527–532. doi:10.1007/s00345-020-03224-w

14. Eltahawy E, Gur U, Virasoro R, Schlossberg SM, Jordan GH. "Management of recurrent anastomotic stenosis following radical prostatectomy using Holmium laser and steroid injection." BJU Int. 2008;102(7):796–798. doi:10.1111/j.1464-410X.2008.07919.x

15. Kravchick S, Lobik L, Peled R, Cytron S. "Transrectal ultrasonography-guided injection of long-acting steroids in the treatment of recurrent / resistant anastomotic stenosis after radical prostatectomy." J Endourol. 2013;27(7):875–879. doi:10.1089/end.2012.0661

16. Palminteri E, Morselli S, Cindolo L, et al. "Iatrogenic or recurrent bladder neck contracture treated by the Palminteri-Ferrari technique: a new way to approach a frustrating condition." World J Urol. 2024;42(1):195. doi:10.1007/s00345-024-04912-7

17. Nehra A, Alterowitz R, Culkin DJ, et al. "Peyronie's disease: AUA guideline." J Urol. 2015;194(3):745–753. doi:10.1016/j.juro.2015.05.098

18. Rosenberg JE, Ergun O, Hwang EC, et al. "Non-surgical therapies for Peyronie's disease." Cochrane Database Syst Rev. 2023;7:CD012206. doi:10.1002/14651858.CD012206.pub2

19. Manfredi C, Russo GI, Capogrosso P, et al. "Injection therapy in the acute phase of Peyronie's disease: a systematic review of current evidence." J Sex Med. 2025;22(5):799–812. doi:10.1093/jsxmed/qdaf044

20. Ure I, Ozen A. "Intralesional low-dose methylprednisolone for the treatment of active-phase Peyronie's disease: a single-centre, preliminary prospective non-randomised study." Int J Clin Pract. 2021;75(3):e13754. doi:10.1111/ijcp.13754

21. Chierigo F, Fallara G, Tozzi M, et al. "Guideline of guidelines: Peyronie's disease." BJU Int. 2026;137(5):770–782. doi:10.1111/bju.70201

22. Manka MG, White LA, Yafi FA, et al. "Comparing and contrasting Peyronie's disease guidelines: points of consensus and deviation." J Sex Med. 2021;18(2):363–375. doi:10.1016/j.jsxm.2020.11.013

23. Ringel NE, Iglesia C. "Common benign chronic vulvar disorders." Am Fam Physician. 2020;102(9):550–557. PMID 33118795

24. Potts BA, Belsante MJ, Peterson AC. "Intraurethral steroids are a safe and effective treatment for stricture disease in patients with biopsy-proven lichen sclerosus." J Urol. 2016;195(6):1790–1796. doi:10.1016/j.juro.2015.12.067

25. Hayden JP, Boysen WR, Peterson AC. "Medical management of penile and urethral lichen sclerosus with topical clobetasol improves long-term voiding symptoms and quality of life." J Urol. 2020;204(6):1290–1295. doi:10.1097/JU.0000000000001304

26. Wilkinson DJ, Lansdale N, Everitt LH, et al. "Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans." J Pediatr Surg. 2012;47(4):756–759. doi:10.1016/j.jpedsurg.2011.10.059

27. Katims AB, Edelblute BT, Tam AW, et al. "Long-term outcomes of laser incision and triamcinolone injection for the management of ureteroenteric anastomotic strictures." J Endourol. 2021;35(1):21–24. doi:10.1089/end.2020.0593

28. Meretyk S, Albala DM, Clayman RV, Denstedt JD, Kavoussi LR. "Endoureterotomy for treatment of ureteral strictures." J Urol. 1992;147(6):1502–1506. doi:10.1016/s0022-5347(17)37608-5

29. Ashraf J, Radford AR, Turner A, Subramaniam R. "Preliminary experience with instillation of triamcinolone acetonide into the urethra for idiopathic urethritis: a prospective pilot study." J Laparoendosc Adv Surg Tech A. 2017;27(11):1217–1221. doi:10.1089/lap.2017.0064

30. Augspurger RR, Wettlaufer JN. "Cushing's syndrome: complication of triamcinolone injection for urethral strictures in children." J Urol. 1980;123(6):932–933. doi:10.1016/s0022-5347(17)56200-x

31. EAU. Urethral Strictures: Disease Management in Males (2026), intralesional adjuncts and posterior endoluminal safety. Guideline.

32. EAU. Paediatric Urology: Phimosis and Other Abnormalities of the Penile Skin (2026). Guideline.

33. EAU. Guidelines on Sexual and Reproductive Health, Limited Update March 2026, section 8.2.3.a.2 (intralesional treatment for Peyronie's disease). Guideline.

34. Kirtschig G, Woelber L, Günthert A, et al. "Evidence- and consensus-based guideline on lichen sclerosus." J Dtsch Dermatol Ges. 2026;24(4):566–584. doi:10.1111/ddg.70000. Full German S3 guideline, June 2025.

35. Soliman C, Pan HYC, Mulholland CJ, et al. "Effect of local steroids on urethral strictures: a systematic review and meta-analysis." Investig Clin Urol. 2022;63(3):273–284. doi:10.4111/icu.20210391

36. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. "Urethral stricture disease guideline amendment (2023)." J Urol. 2023;210(1):64–71. doi:10.1097/JU.0000000000003482

37. Verla W, Barratt R, Chan G, et al. "Is a course of intermittent self-dilatation with topical corticosteroids superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of intermittent self-dilatation alone? A systematic review and meta-analysis." Eur Urol Open Sci. 2023;51:95–105. doi:10.1016/j.euros.2023.01.011

38. DailyMed. Kenalog-10 (triamcinolone acetonide injectable suspension) prescribing information, label effective August 2024. Label.

39. Doiron RC, Tadayon B, Violette PD, et al. "2025 Canadian Urological Association Guideline: Selected treatment recommendations for interstitial cystitis/bladder pain syndrome." Can Urol Assoc J. 2025;19(4):90–103. doi:10.5489/cuaj.9182

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