Background and aim: To find if intra-operative local injection of Mitomycin-C after internal Urethrotomy in patients with urethral stricture can improve the outcome of surgery.
Materials and Methods: Seventy patients were allocated in two groups randomly and data were analyzed. The case group (n=35) was treated by internal Urethrotomy with intra-operative local injection of Mitomycin-C. The control group (n=35) was underwent standard internal Urethrotomy. The patients were followed after removing catheter and for 6 months after surgery by USS PROM questionnaire and uroflowmetry.
Results: A significant difference was observed in terms of urodynamic indices like Q-max (p-value=0.006) and urine flow pattern (p-value=0.025) after internal Urethrotomy in the local injection of Mitomycin-C group and control group, six months after surgery. In the case group, in the six months after operation, only 2.9% of patients had Q-max less than 15 and no one had obstructive pattern, while in the control group, 25.7% of patients had Q- max less than 15 and 17.1% had obstructive pattern. However, the patient's satisfaction history did not show any significant difference in post-internal Urethrotomy voiding status in the local injection of Mitomycin-C group and control group, either immediately after removal of the urethral catheter (p-value=1) and six months after surgery (p-value=0.198). Also, no significant difference was observed in terms of urodynamic indices like Q-max (p-value=0.771) and urine flow pattern (p-value=1) after internal Urethrotomy in the local injection of Mitomycin-C group and control group, immediately after removal of the urethral catheter.
Conclusions: Intra-operative local injection of Mitomycin-C after internal Urethrotomy can be regarded as a safe and efficient technique which has several advantages including lower cost. Lower recurrence rate of urethral stricture is the main effect of local Mitomycin-C application that is more prominent after six months follow up.
Col. S. K. Dey, M. Bajpai, N. Sharma. Anterior Urethral Strictures: Causes and Current Management Strategies. Journal of Progress in Paediatric Urology, May-Aug 2014, Vol 17, Issue 2
EnzoPalminteri, Elisa Berdondini, Paolo Verze, Cosimo, De Nunzio, Antonio Vitarelli, Luca Carmignani. Contemporary Urethral Stricture Characteristics in the Developed World. Urology. 2013;81:190-97.
Nuss GR, Granieri MA, Zhao LC. Presenting symptoms of anterior urethral stricture disease: a disease specific, patient reported questionnaire to measure outcomes. J Urol 2012;187:559-62.
ALI AYYILDIZ, BARIS NUHOGLU, BÜLENT GÜLERKAYA, MUZAFFER ÇAYDERE, HÜSEYIN ÜSTÜN, CANKON GERMIYANOGLU AND DEMOKAN EROL. Effect of intraurethral Mitomycin-C on healing and fibrosis in rats with experimentally induced urethral stricture. International Journal of Urology (2004) 11, 1122–1126.
Hamid Mazdak, Iraj Meshki, Fatemeh Ghassami. Effect of Mitomycin C on Anterior Urethral Stricture Recurrence after Internal Urethrotomy. european urology 51 ( 2 0 0 7 ) 1089–1092.
Jordan GH, Schlossberg SM (2007) Surgery of penis and urethra. In: Wein AJ, Kavoussi LR, Novick AC (eds) Campbell-Walsh urology, 9th edn. Saunders, Philadelphia, pp 1055–1075
Lumen N, Hoebeke P, Willemsen P. Etiology of urethral stricture disease in the 21st century. J Urol. 2009;182:983-87.
Mehdi Shirazi, Abdolaziz Khezri, Soleiman Mohammadi Samani, Ahmad Monabbati, Javad Kojoori and Abbas Hassanpour. Effect of intraurethral captopril gel on the recurrence of urethral stricture after direct vision internal urethrotomy: Phase II clinical trial. International Journal of Urology (2007) 14, 203–208.
Andrich DE, Mundy AR. Urethral Strictures and their surgical treatment. BJU Int. 2000; 86: 571–9.
Hamid Mazdak , Mohammad Hossein Izadpanahi , Asghar Ghalamkari ,Mahmoud Kabiri , Mohammad-Hatef Khorrami , Kia Nouri-Mahdavi ,Farshid Alizadeh , Mahtab Zargham , Farhad Tadayyon ,Ahmad Mohammadi ,Mohammad Yazdani. Internal urethrotomy and intraurethral submucosal injection of triamcinolone in short bulbar urethral strictures. Int Urol Nephrol (2010) 42:565–568
Erol D, Altug U, Horasanl K et al. Internal urethrotomy in the treatment of the urethral strictures. Turk. J. Urol.1994; 20: 153–7.
Alex J. Vanni, Leonard N. Zinman and Jill C. Buckley. Radial Urethrotomy and Intralesional Mitomycin C for the Management of Recurrent Bladder Neck Contractures. Vol. 186, 156-160, July 2011.
Anger JT, Raj GV, Delvecchio FC et al: Anastomotic contracture and incontinence after radical prostatectomy: a graded approach to management. J Urol 2005; 173: 1143.
Elliott DS and Boone TB: Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a longterm evaluation. J Urol 2001; 165: 413.
Bodker A, Ostri P, Rye-Andersen J, Edvardsen L, Struckmann J. Treatment of recurrent urethral stricture by internal urethrotomy and intermittent selfcatheterization: a controlled study of a new therapy. J Urol. 1992;148(2 Pt 1):308-10.
Stormont TJ, Suman VJ, Oesterling JE. Newly diagnosed bulbar urethral strictures: etiology and outcome of various treatment. J. Urol. 1984; 56: 308.
Santucci RA, McAninch JW. Actuarial success rates of open urethral stricture repair in 369 patients. J Uro 2001;165:13.
Giovanni UM (2002) Treatment of scars by steroid injections. Wound Repair Regen 10(2):116–117
Range JI, Rumalla A, Baron TH et al (2005) A prospective, randomized double-blind, placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures. Am J Gastroenterol 100(11):2419–2425
Snodgrass W (1999) Triamcinolone to prevent stenosis in Mitrofanoff stomas. J Urol 161:928.
Korhonen P, Talja M, Rutu M, Alfthan O (1990) Intralesional corticosteroid injections in combination with internal urethrotomy in the treatment of urethral strictures. Int Urol Nephrol 22(3):263–269.
Hradec E, Jarolim L, Petric R (1981) Optical internal urethrotomy for strictures of male the male urethra. Effect of local steroid injection. Eur Urol 7(3):165–168.
Jeffrey D. Redshaw, Joshua A. Broghammer, Thomas G. Smith III, Bryan B. Voelzke, Bradley A. Erickson, Christopher D. McClung, Sean P. Elliott, Nejd F. Alsikafi, Angela P. Presson, Michael E. Aberger, James R. Craig, William O. Brant and Jeremy B. Myers. Intralesional Injection of Mitomycin C at Transurethral Incision of Bladder Neck Contracture May Offer Limited Benefit: TURNS Study Group. THE JOURNAL OF UROLOGY®Vol. 193, 587-592, February 2015.
M. Ryan Farrell MD, MPH; Cedric Lawrenz BS; Laurence A. Levine, MD. Internal Urethrotomy with Intralesional Mitomycin C: An Effective Option for Endoscopic Management of Recurrent Bulbar and Bulbomembranous Urethral Strictures. http://dx.doi.org/doi: 10.1016/j.urology.2017.07.017.
Michael R. Farrell, Benjamin A. Sherer, and Laurence A. Levine. Visual Internal Urethrotomy with Intralesional Mitomycin C and Short-term Clean Intermittent Catheterization for the Management of Recurrent Urethral Strictures and Bladder Neck Contractures. UROLOGY 85 (6), 20.
Seyed Jalil Hosseini, Ali Kaviani, Ali Reza Vazirnia. Internal Urethrotomy Combined with Antegrade Flexible Cystoscopy for Management of Obliterative Urethral Stricture. Urol J. 2008;5:184-7.www.uj.unrc.ir.