Korean J Urol.  2015 Sep;56(9):650-655. 10.4111/kju.2015.56.9.650.

Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy

• Ali L
• Shahzad M
• Orakzai N
• Khan I
• Ahmad M

• KMID: 2344104
• DOI: http://doi.org/10.4111/kju.2015.56.9.650

Abstract

PURPOSE
To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU).
MATERIALS AND METHODS
This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS.
RESULTS
The mean age of the patients in group A was 37.31+/-10.1 years and that in group B was 40.1+/-11.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002).
CONCLUSIONS
Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU.

Keyword

Surgery; Urethral diseases; Urethral stricture; Urinary bladder neck obstruction

MeSH Terms

Adult
Follow-Up Studies
Humans
Injections, Intralesional
Male
Middle Aged
Mitomycin/*administration & dosage
Nucleic Acid Synthesis Inhibitors/*administration & dosage
Recurrence
Time Factors
Urethral Stricture/*prevention & control/radiography/surgery
Urodynamics
Urologic Surgical Procedures/methods
Mitomycin
Nucleic Acid Synthesis Inhibitors

Figure

• 

  Fig. 1 Bar graph showing different etiological factors in urethral stricture. Pearson chi-square=0.164.

• 

  Fig. 2 Bar graph showing site of urethral stricture.

Reference

1. Santucci RA, Joyce GF, Wise M. Male urethral stricture disease. J Urol. 2007; 177:1667–1674.

2. Mundy AR. Management of urethral strictures. Postgrad Med J. 2006; 82:489–493.

3. Sachse H. Treatment of urethral stricture: transurethral slit in view using sharp section. Fortschr Med. 1974; 92:12–15.

4. Zehri AA, Ather MH, Afshan Q. Predictors of recurrence of urethral stricture disease following optical urethrotomy. Int J Surg. 2009; 7:361–364.

5. Sangkum P, Levy J, Yafi FA, Hellstrom WJ. Erectile dysfunction in urethral stricture and pelvic fracture urethral injury patients: diagnosis, treatment, and outcomes. Andrology. 2015; 3:443–449.

6. Bazo A, Rao K. Urethral strictures: 'once a stricture, always a stricture'. Trop Doct. 2003; 33:69–71.

7. Heyns CF, van der Merwe J, Basson J, van der Merwe A. Treatment of male urethral strictures - possible reasons for the use of repeated dilatation or internal urethrotomy rather than urethroplasty. S Afr J Surg. 2012; 50:82–87.

8. Islam M, Anwar F, Ahmed S, Ali A. Optical urethrotomy in strictures following fracture pelvis. J Ayub Med Coll Abbottabad. 2010; 22:106–108.

9. Ali MN. Experience with cold knife optical internal urethrotomy. J Coll Physicians Surg Pak. 2001; 11:693.

10. Dubey D. The current role of direct vision internal urethrotomy and self-catheterization for anterior urethral strictures. Indian J Urol. 2011; 27:392–396.

11. Santucci R, Eisenberg L. Urethrotomy has a much lower success rate than previously reported. J Urol. 2010; 183:1859–1862.

12. Jampel HD. Effect of brief exposure to mitomycin C on viability and proliferation of cultured human Tenon's capsule fibroblasts. Ophthalmology. 1992; 99:1471–1476.

13. Yamamoto T, Varani J, Soong HK, Lichter PR. Effects of 5-fluorouracil and mitomycin C on cultured rabbit subconjunctival fibroblasts. Ophthalmology. 1990; 97:1204–1210.

14. Ayyildiz A, Nuhoglu B, Gulerkaya B, Caydere M, Ustun H, Germiyanoglu C, et al. Effect of intraurethral Mitomycin-C on healing and fibrosis in rats with experimentally induced urethral stricture. Int J Urol. 2004; 11:1122–1126.

15. Ferguson GG, Bullock TL, Anderson RE, Blalock RE, Brandes SB. Minimally invasive methods for bulbar urethral strictures: a survey of members of the American Urological Association. Urology. 2011; 78:701–706.

16. Khan S, Khan RA, Ullah A, ul Haq F, ur Rahman A, Durrani SN, et al. Role of clean intermittent self catheterisation (CISC) in the prevention of recurrent urethral strictures after internal optical urethrotomy. J Ayub Med Coll Abbottabad. 2011; 23:22–25.

17. Jackson MJ, Veeratterapillay R, Harding CK, Dorkin TJ. Intermittent self-dilatation for urethral stricture disease in males. Cochrane Database Syst Rev. 2014; 12:CD010258.

18. Xu YM, Song LJ, Wang KJ, Lin J, Sun G, Yue ZJ, et al. Changing trends in the causes and management of male urethral stricture disease in China: an observational descriptive study from 13 centres. BJU Int. 2014; 10. 07. [Epub]. DOI: 10.1111/bju.12945.

19. Stein DM, Thum DJ, Barbagli G, Kulkarni S, Sansalone S, Pardeshi A, et al. A geographic analysis of male urethral stricture aetiology and location. BJU Int. 2013; 112:830–834.

20. Mazdak H, Meshki I, Ghassami F. Effect of mitomycin C on anterior urethral stricture recurrence after internal urethrotomy. Eur Urol. 2007; 51:1089–1092.

21. Mundy AR. Adjuncts to visual internal urethrotomy to reduce the recurrence rate of anterior urethral strictures. Eur Urol. 2007; 51:1467–1468.

22. Vanni AJ. New frontiers in urethral reconstruction: injectables and alternative grafts. Transl Androl Urol. 2015; 4:84–91.

23. Kumar S, Garg N, Singh SK, Mandal AK. Efficacy of optical internal urethrotomy and intralesional injection of Vatsala-Santosh PGI tri-inject (triamcinolone, mitomycin c, and hyaluronidase) in the treatment of anterior urethral stricture. Adv Urol. 2014; 2014:192710.

24. Chung JH, Kang DH, Choi HY, Jeong TY, Ha US, Han JH, et al. The effects of hyaluronic acid and carboxymethylcellulose in preventing recurrence of urethral stricture after endoscopic internal urethrotomy: a multicenter, randomized controlled, single-blinded study. J Endourol. 2013; 27:756–762.

25. Kumar S, Kapoor A, Ganesamoni R, Nanjappa B, Sharma V, Mete UK. Efficacy of holmium laser urethrotomy in combination with intralesional triamcinolone in the treatment of anterior urethral stricture. Korean J Urol. 2012; 53:614–618.

26. Erickson BA, Breyer BN, McAninch JW. Changes in uroflowmetry maximum flow rates after urethral reconstructive surgery as a means to predict for stricture recurrence. J Urol. 2011; 186:1934–1937.