Redshaw JD, Broghammer JA, Smith TG 3rd, Voelzke BB, Erickson BA, McClung CD, Elliott SP, Alsikafi NF, Presson AP, Aberger ME, Craig JR, Brant WO, Myers JB

J Urol. 2014 Sep 5. pii: S0022-5347(14)04359-6. doi: 10.1016/j.juro.2014.08.104. [Epub ahead of print]

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Abstract

INTRODUCTION: Injection of mitomycin C (MMC) may increase the success of transurethral incision of the bladder neck (TUIBN) for the treatment of bladder neck contracture (BNC). Our aim was to evaluate the efficacy of MMC injection across multiple institutions.

MATERIALS AND METHODS:

Data on all patients undergoing TUIBN with MMC from 2009-2014 were retrospectively reviewed from six centers in the Trauma and Urologic Reconstruction Network of Surgeons (TURNS). Patients with at least three months of cystoscopic follow up were included for analysis.

RESULTS:

66 patients underwent TUIBN with MMC and 55 meeting inclusion criteria were included in the analysis. Mean age was 64 ± 7.6 years. 80% (44/55) of patients had failed either dilation or prior TUIBN. 58% (32/55) achieved resolution of their BNC after one TUIBN with MMC at a median follow up of 9.2 months (IQR 11.7). Recurrence occurred in 23 patients at a median of 3.7 months (IQR 4.2) - 15 underwent a repeat TUIBN with MMC and 60% (9/15) were free from another recurrence at a median 8.6 months (IQR 8.8) for a overall success rate of 75% (41/55). 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 MMC; three needed or are planning cystectomy.

CONCLUSION:

The efficacy of intralesional injection of MMC at the time of TUIBN was lower than previously reported and was associated with a 7% rate of serious adverse events.

Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Contracture/surgery; Mitomycin/administration & dosage; Urinary Bladder Neck Obstruction/drug therapy; Urinary Bladder Neck Obstruction/surgery; Urinary Incontinence