Intralesional Injection of Mitomycin C Following Visual Internal Urethrotomy for Recurrent Urethral Stricture

Abstract Background Urethral stricture is one of the oldest known urologic diseases with high recurrence rate. It is defined as narrowing of the urethral lumen caused by scarring. Injuries to the urethral epithelium or the underlying corpus spongiosum may lead to scar formation which causes narrowing of the urethral lumen leading to urethral stricture and spongiofibrosis which can lead to total replacement of the spongy tissue by scar tissue. Aim of the Work To asses the efficacy of Intralesional injection of mitomycin C following visual internal urethrotomy (VIU) in the management of recurrent urethral stricture. Patients and Methods This is prospective randomized interventional study carried on 50 male patients with recurrent bulbar urethral stricture of < 1.5 cm. They were randomised to undergo either VIU only (Group-A) or VIU with MMC injections (Group-B). The urethrotomy was performed under direct vision using a cold-knife and incisions were made at the 12-, 3-, and 9- o’clock positions followed by intralesional injection of 10 mL MMC (0.4 mg/mL) using Botox injection needle. All patients were objectively evaluated pre- and postoperatively at 3 and 6 months using uroflowmetry (maximum urinary flow rate), post-void residual urine volume, and retrograde urethrography. Results Of all 50 patients; five missed follow-up (three in Group-A, two in Group-B), therefore 45 cases were available for analysis (22 in Group-A and 23 in Group-B). The mean (SD) age of patients was 32.0 (8.1) and 34.0 (6.2) years in Group-A and Group-B, respectively (P = 0.314). The most common cause of a urethral stricture in both groups was iatrogenic injury. Regarding stricture recurrence, there was significant decrease in Group-B (four patients, 17.4%) compared with Group- A; (ten patients, 45.5%) (P = 0.042). This study demonstrated that visual internal urethrotomy for recurrent urethral stricture with intralesional injection of 10 mL mitomycin C MMC (0.4mg/mL) decreases the recurrence rate of the urethral stricture. Conclusion Intralesional injection of mitomycin C following visual internal urethrotomy for recurrent urethral stricture seems to be a safe and effective modality of treatment in reducing the incidence of recurrent stricture after VIU.