A Multi-Institutional Experience Comparing Internal Urethrotomy with Intralesional Mitomycin C for Recurrent Bladder Neck Contractures in Radiated vs. Non-Radiated Patients
Alexander Rozanski, MD1, Lawrence Zhang, BA1, Daniel Holst, MD2, Steven Copacino, BA1, Alex Vanni, MD1, Jill Buckley, MD2.
1Lahey Hospital and Medical Center, Burlington, MA, 2UC San Diego, San Diego, CA.
Background: We have previously published our initial and intermediate-term experience with direct visual internal urethrotomy (DVIU) and intralesional mitomycin C (MMC) for recurrent bladder neck contractures (BNC). This study highlights our continued durable results in addressing this challenging clinical problem and specifically focuses on success rates in radiated vs. non-radiated groups.
Methods: A retrospective review was performed of all patients who underwent DVIU with intralesional MMC for BNC between 2007 and 2019 at two institutions. Cold knife incisions were performed in a reproducible fashion followed by injection of 0.3 to 0.4 mg/ml MMC at each incision site. Patients with evidence of complete urethral obliteration, strictures of the entire posterior urethra, or less than 3 month follow-up were excluded. Success was defined as the ability to pass a 17-French cystoscope postoperatively without the need for catheterization or dilation.
Results: A total of 86 patients were included in our analysis. The vast majority (91%) had at least 1 prior DVIU, 55% had at least 1 prior dilation or required a specific dilation schedule, and 44% presented with an indwelling catheter or performed intermittent catheterization. At a median follow-up of 21 months, the overall success rate was 90% (65% after 1 procedure, 83% after 2 procedures, and 90% after 3 or more procedures). Non-radiated patients showed a significantly higher success rate compared to radiated patients (94% vs. 76%, p = 0.04)(Table 1). Of the 9 patients with cystoscopic failure, 5 had minimal urinary symptoms and pursued observation. Only 2 patients with a history of previous catheterization or urethral dilation required this postoperatively. Two patients underwent subsequent urinary diversion. Rigorous follow-up showed no long-term overall or MMC-specific complications.
Conclusions: Radical DVIU with intralesional MMC continues to prove to be a safe and durable treatment strategy for BNC from various etiologies, although success rates are exceptional in patients without a history of pelvic radiation.
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