European Urology

Abstract

Objectives

Urethral stricture is one of the oldest known urologic diseases and remains a common problem with high morbidity. Internal urethrotomy refers to any procedure that opens the stricture by incising or ablating it transurethrally. The most common complication of internal urethrotomy is stricture recurrence. The curative success rate of internal urethrotomy is approximately 20%. Mitomycin C has antifibroblast and anticollagen properties and in sporadic reports of animal and clinical studies it has increased the success rate of trabeculectomy and myringotomy. This study evaluated the efficacy of mitomycin C in the prevention of anterior urethral stricture recurrence after internal urethrotomy.

Patients and methods

Forty male patients with anterior urethral strictures were randomized to undergo internal urethrotomy with or without urethral submucosal mitomycin C injection. Using general anaesthesia, the urethrotomy was performed under direct vision. Mitomycin C (0.1 mg) was injected submucosally at the urethrotomy site in 20 patients. The patients were re-evaluated after 6 mo and the stricture recurrence rate was compared between the two groups (χ² analysis).

Results

Urethral stricture recurred in 2 patients (10%) in the mitomycin C-treated group and in 10 patients (50%) in the other group. This difference in stricture recurrence between the two groups was statistically significant (p = 0.006).

Conclusions

To our knowledge, this is the first prospective, randomized, clinical trial to evaluate the efficacy of mitomycin C application in internal urethrotomy. Submucosal injection of mitomycin C significantly reduced stricture recurrence after internal urethrotomy. Further investigations are warranted to confirm its efficacy and safety.

Take Home Message

Urethral stricture is a common urologic problem with a dismal treatment success rate. Mitomycin C, an alkylating antineoplastic antibiotic drug, has antifibrotic effects. This is the first prospective, randomized, clinical trial evaluating efficacy of mitomycin C in internal urethrotomy.