Radial Urethrotomy and Intralesional Mitomycin C for the Management of Recurrent Bladder Neck Contractures

No AccessJournal of UrologyAdult Urology1 Jul 2011Radial Urethrotomy and Intralesional Mitomycin C for the Management of Recurrent Bladder Neck Contractures Alex J. Vanni, Leonard N. Zinman, and Jill C. Buckley Alex J. VanniAlex J. Vanni More articles by this author , Leonard N. ZinmanLeonard N. Zinman More articles by this author , and Jill C. BuckleyJill C. Buckley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.03.019AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated urethrotomy combined with intralesional injection of the antiproliferative agent mitomycin C for the treatment of severe, recurrent bladder neck contractures after traditional endoscopic management failed. We report our experience with radial urethrotomy and intralesional mitomycin C in patients with recurrent bladder neck contractures. Materials and Methods: A retrospective review was performed of patients evaluated for severe, recurrent bladder neck contractures between January 2007 and April 2010. All patients had at least 1 prior failed incision of a bladder neck contracture. Tri or quadrant cold knife incisions of the bladder neck were performed followed by injection of 0.3 to 0.4 mg/ml mitomycin C at each incision site. Results: A total of 18 patients were treated with bladder neck incision and mitomycin C injection. Preoperatively 4 (22%) patients presented with indwelling Foley catheters while 7 (39%) required a dilation schedule. At a median followup of 12 months (range 4 to 26) 13 patients (72%) had a patent bladder neck after 1 procedure, as did 3 (17%) after 2 procedures and 1 after 4 procedures. All of the patients presenting with a prior indwelling urethral catheter or requiring a dilation schedule had a stable, patent bladder neck. Conclusions: Management of recurrent bladder neck contractures with radial urethrotomy combined with intralesional mitomycin C resulted in bladder neck patency in 72% of the patients after 1 procedure and in 89% after 2 procedures. Although early results are promising, longer followup and randomized, prospective studies are required to validate these findings. References 1 : Radical prostatectomy: prospective assessment of mortality and morbidity. Eur Urol1996; 29: 168. Google Scholar 2 : Early and late complications of radical retropubic prostatectomy: experience in a single institution. Jpn J Clin Oncol2004; 34: 274. Google Scholar 3 : Anastomotic strictures following radical prostatectomy: risk factors and management. J Urol1990; 143: 755. Link, Google Scholar 4 : Iatrogenic prostatic urethral strictures: classification and endoscopic treatment. Urology1999; 53: 784. Google Scholar 5 : Anastomotic stricture after radical prostatectomy: Incidence, findings and treatment . Eur Urol1998; 33: 382. Google Scholar 6 : Bladder neck contracture after radical retropubic prostatectomy. BJU Int2004; 94: 1245. Google Scholar 7 : Two-stage transperineal management of posterior urethral strictures or bladder neck contractures associated with urinary incontinence after prostate surgery and endoscopic treatment failures. Eur Urol2007; 52: 1499. Google Scholar 8 : Incontinence after surgery for benign prostatic hypertrophy: the case for complex approach and treatment. Eur Urol1998; 33: 370. Google Scholar 9 : Anastomotic contracture and incontinence after radical prostatectomy: a graded approach to management. J Urol2005; 173: 1143. Link, Google Scholar 10 : Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. J Urol2001; 165: 413. Link, Google Scholar 11 : Outcome analysis of urethral wall stent insertion with artificial urinary sphincter placement for severe recurrent bladder neck contracture following radical prostatectomy. J Urol2009; 181: 1236. Link, Google Scholar 12 : Incidence of urethral stricture after primary treatment for prostate cancer: data from CaPSURE. J Urol2007; 178: 529. Link, Google Scholar 13 : Long term consequences in the management of the devastated, obstructed outlet using combined Urolume stent with subsequent artificial urinary sphincter placement. J Urol2010; 183: e427. abstract 1097. Link, Google Scholar 14 : Time and dose effects of mitomycin C on extracellular matrix fibroblasts and proteins. Laryngoscope2005; 115: 110. Google Scholar 15 : Effect of mitomycin C on keloid fibroblasts: an in vitro study. Ann Plast Surg2003; 50: 71. Google Scholar 16 : Effect of intraurethral mitomycin-C on healing and fibrosis in rats with experimentally induced urethral stricture. Int J Urol2004; 11: 1122. Google Scholar 17 : Nine-year follow-up of trabeculectomy with or without low-dosage mitomycin-c in primary open-angle glaucoma. Br J Ophthalmol2008; 92: 1666. Google Scholar 18 : Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up. Ophthalmology2002; 109: 1336. Google Scholar 19 : Studies on the pterygium: V. Follow-up information of mitomycin C treatment . Nippon Ganka Gakkai Zasshi1967; 71: 351. Google Scholar 20 : Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in nasolacrimal duct obstruction in adults. Ophthalmology2010; 117: 1037. Google Scholar 21 : The efficacy of mitomycin-C in the treatment of laryngotracheal stenosis. Laryngoscope2006; 116: 1923. Google Scholar 22 : Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one?. Laryngoscope2009; 119: 272. Google Scholar 23 : Mitomycin-c application in airway stenosis surgery: analysis of safety and costs. Otolaryngol Head Neck Surg2006; 134: 403. Google Scholar 24 : Successful topical treatment with mitomycin-C in a female with post-brachytherapy vaginal stricture. Pediatr Blood Cancer2008; 51: 550. Google Scholar 25 : Topical mitomycin-C for the treatment of anal stricture. J Pediatr Surg2010; 45: 241. Google Scholar 26 : Effect of mitomycin C on anterior urethral stricture recurrence after internal urethrotomy. Eur Urol2007; 51: 1089. Google Scholar Institute of Urology, Lahey Clinic Medical Center, Burlington, Massachusetts© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byWessells H, Morey A, Souter L, Rahimi L and Vanni A (2023) Urethral Stricture Disease Guideline Amendment (2023)Journal of Urology, VOL. 210, NO. 1, (64-71), Online publication date: 1-Jul-2023.Raheem O, Khandwala Y, Hsieh T and Buckley J (2016) Review Article: Is There a Role for Antifibrotics in the Treatment of Urological Disease? A Systematic Review of the LiteratureUrology Practice, VOL. 5, NO. 1, (31-38), Online publication date: 1-Jan-2018.Wessells H, Angermeier K, Elliott S, Gonzalez C, Kodama R, Peterson A, Reston J, Rourke K, Stoffel J, Vanni A, Voelzke B, Zhao L and Santucci R (2016) Male Urethral Stricture: American Urological Association GuidelineJournal of Urology, VOL. 197, NO. 1, (182-190), Online publication date: 1-Jan-2017.Raheem O, Liss M and Buckley J (2016) Therapeutic Use of Mitomycin C for Urological Conditions: Systematic Review of the LiteratureUrology Practice, VOL. 3, NO. 4, (283-288), Online publication date: 1-Jul-2016.LaBossiere J, Cheung D and Rourke K (2015) Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of SuccessJournal of Urology, VOL. 195, NO. 5, (1495-1500), Online publication date: 1-May-2016.Nagpal K, Zinman L, Lebeis C, Vanni A and Buckley J (2015) Durable Results of Mitomycin C Injection with Internal Urethrotomy for Refractory Bladder Neck Contractures: Multi-institutional ExperienceUrology Practice, VOL. 2, NO. 5, (250-255), Online publication date: 1-Sep-2015.Redshaw J, Broghammer J, Smith T, Voelzke B, Erickson B, McClung C, Elliott S, Alsikafi N, Presson A, Aberger M, Craig J, Brant W and Myers J (2014) Intralesional Injection of Mitomycin C at Transurethral Incision of Bladder Neck Contracture May Offer Limited Benefit: TURNS Study GroupJournal of Urology, VOL. 193, NO. 2, (587-592), Online publication date: 1-Feb-2015.Morey A (2014) Re: Deep Lateral Transurethral Incisions for Recurrent Bladder Neck Contracture: Promising 5-Year Experience Using a Standardized ApproachJournal of Urology, VOL. 192, NO. 2, (447-448), Online publication date: 1-Aug-2014. Volume 186Issue 1July 2011Page: 156-160 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordsmitomycinurethraurinary bladder neck obstructionMetricsAuthor Information Alex J. Vanni More articles by this author Leonard N. Zinman More articles by this author Jill C. Buckley More articles by this author Expand All Advertisement PDF downloadLoading ...