Objectives: To assess the efficacy of intralesional injection of mitomycin C (MMC), using a novel adjustable-tip needle, following visual internal urethrotomy (VIU) in reducing the recurrence of de novo bulbar urethral stricture disease (USD). Patients and methods: Using closed envelopes, 50 patients diagnosed with bulbar USD of <2 cm were randomised to undergo either VIU with MMC injections (Group-A) or VIU alone (Group-B). The urethrotomy was performed under direct vision using a cold-knife and incisions were made at the 12-, 4-, and 8-o'clock positions followed by intralesional injection of 10 mL MMC (0.4 mg/mL) using a novel depth-adjusting needle. All patients were objectively evaluated pre- and postoperatively at 3, 6, and 9 months using uroflowmetry (maximum urinary flow rate), post-void residual urine volume, and retrograde urethrography. Results: Of all 50 patients; five missed follow-up (four in Group-A, one in Group-B), hence 45 cases were available for analysis (21 in Group-A and 24 in Group-B). The mean (SD) age of patients was 34.33 (7.2) and 37.7 (10.2) years in Group-A and Group-B, respectively (P = 0.22). The depth-adjusting needle was easy to use and all injections were successfully completed. In terms of stricture recurrence, there was significant decrease in Group-A (three patients, 14.3%) compared with Group-B; (12 patients, 50%) (P = 0.01). On multivariate Cox regression analysis, the VIU with MMC was found as a sole factor associated with marked decrease in stricture recurrence (hazard ratio 0.23, 95% confidence interval 0.06-0.93; P = 0.04). The Kaplan-Meier survival curve for recurrence-free survival showed a statistically significant difference between both groups (85.7% vs 50.0%; chi-squared = 7.079, P = 0.008). Conclusion: The use of a novel depth-adjusting needle was easily applied and MMC injection after VIU resulted in a significantly lower recurrence of de novo bulbar USD. Abbreviations : MMC: mitomycin C; PVR: post-voiding residual urine; Qmax: maximum urinary flow rate; RFS: recurrence-free survival; RUG: retrograde urethrography; USD: urethral stricture disease; VIU: visual internal urethrotomy.
Arab journal of urology. 2021 Mar 01*** epublish ***
Yasser A Noureldin, Abdallah Fathy, Shabib Ahmed, Alaa El Shaer, Saad Ali, Zakaria Saki, Ahmed Sebaey
Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt., Department of Urology, Milton Keynes University Hospital, Milton Keynes, UK.