Intralesional Injection of Mitomycin C at Transurethral Incision of Bladder Neck Contracture May Offer Limited Benefit: TURNS Study Group

Abstract

Purpose Injection of mitomycin C may increase the success of transurethral incision of the bladder neck for the treatment of bladder neck contracture. We evaluated the efficacy of mitomycin C injection across multiple institutions. Materials and Methods Data on all patients who underwent transurethral incision of the bladder neck with mitomycin C from 2009 to 2014 were retrospectively reviewed from 6 centers in the TURNS. Patients with at least 3 months of cystoscopic followup were included in the analysis. Results A total of 66 patients underwent transurethral incision of the bladder neck with mitomycin C and 55 meeting the study inclusion criteria were analyzed. Mean ± SD patient age was 64 ± 7.6 years. Dilation or prior transurethral incision of the bladder neck failed in 80% (44 of 55) of patients. Overall 58% (32 of 55) of patients achieved resolution of bladder neck contracture after 1 transurethral incision of the bladder neck with mitomycin C at a median followup of 9.2 months (IQR 11.7). There were 23 patients who had recurrence at a median of 3.7 months (IQR 4.2), 15 who underwent repeat transurethral incision of the bladder neck with mitomycin C and 9 of 15 (60%) who were free of another recurrence at a median of 8.6 months (IQR 8.8), for an overall success rate of 75% (41 of 55). Incision with electrocautery (Collins knife) was predictive of success compared with cold knife incision (63% vs 50%, p=0.03). Four patients experienced serious adverse events related to mitomycin C and 3 needed or are planning cystectomy. Conclusions The efficacy of intralesional injection of mitomycin C at transurethral incision of the bladder neck was lower than previously reported and was associated with a 7% rate of serious adverse events.

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

“…Despite its success, there was a 7% complication rate, most notably, osteitis pubis and rectourethral fistula and three patients were scheduled to undergo cystectomy at the time of publication. 57 Not all series report such morbid complications using MMC in this setting. In a multi-institutional retrospective review over a 7-year period, durable results with acceptable complication rates were obtained with injection of MMC for refractory VUAS.…”

Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of Success

“…While these agents may prove valuable in the treatment of recalcitrant VUS, significant adverse events have been reported 4 . Overall, it appears that patients with VUS can usually be successfully stenosis after radical prostatectomy.…”

“…Despite advances in operative technique, such as the implementation of robotic assisted surgery, vesicourethral anastomotoic stenosis (VUS) remains a significant complication related to the procedure, with an incidence ranging between 1-30% [1][2][3][4][5] . Multiple patient and procedural factors have been attributed to the occurrence of VUS post-radical prostatectomy, including advanced patient age, radiotherapy, increased body mass index (BMI), surgeon technique/volume, postoperative hematoma or urinary leak, increased pathologic tumor stage or grade, prior transurethral resection of the prostate gland, and history of tobacco use [6][7][8][9][10] .…”

Effect of adipose tissue-derived stem cell injection in a rat model of urethral fibrosis

“…[8][9][10] Results of these different treatment options remain inconsistent and, as such, none of these modalities have been widely adopted.…”

“…6,7 Current adjunctive treatments that aim to improve treatment outcomes include injection of mitomycin c and steroids. [8][9][10] Results of these different treatment options remain inconsistent and, as such, none of these modalities have been widely adopted.…”