EFFICACY OF INTRALESIONAL MITOMYCIN-C AFTER OPTICAL INTERNAL URETHROTOMY IN REDUCING RECURRENCE OF ANTERIOR URETHRAL STRICTURES

Abstract

Background: Urethral stricture is a common urological condition characterized by fibrosis and narrowing of the anterior urethra, leading to lower urinary tract symptoms and a significant impact on quality of life. Optical internal urethrotomy (OIU) is a minimally invasive procedure frequently used for treatment; however, high recurrence rates remain a major challenge. Adjunctive therapies, such as intralesional mitomycin-C, have shown promise in reducing fibrosis and improving surgical outcomes. This study evaluates the efficacy of intralesional mitomycin-C in preventing recurrence after OIU.

Objective: To assess the effectiveness of intralesional mitomycin-C in reducing the recurrence of anterior urethral strictures following OIU.

Methods: A randomized controlled trial was conducted at the Urology Department of Bahawal Victoria Hospital, enrolling 100 patients aged 20–70 years with anterior urethral strictures. Patients with neurogenic bladder, fully obliterated strictures, untreated urinary tract infections, prior urethroplasty or OIU, or immunosuppressive medication use were excluded. Participants were randomly assigned into two equal groups. Group A underwent OIU followed by a submucosal injection of 0.1 mg mitomycin-C (diluted in 2 cc distilled water) at the urethrotomy site, while Group B underwent OIU alone. A 16 Fr Foley catheter was inserted in both groups for three days postoperatively. Follow-up visits occurred biweekly for three months, and efficacy was assessed based on recurrence-free status. Statistical analysis was performed using IBM SPSS version 25.0, with a p-value of <0.05 considered significant.

Results: The mean age of participants was 44.21 ± 7.88 years, with similar distributions in Group A (44.24 ± 7.92 years) and Group B (44.22 ± 7.44 years). The majority of patients (53.1%) were aged 20–45 years. The mean stricture length was 29.42 ± 2.93 mm, and the average duration was 4.32 ± 1.57 months in both groups. Efficacy was significantly higher in Group A (34 patients, 68.0%) compared to Group B (17 patients, 34.0%) (p = 0.0007). Stratified analysis showed a statistically significant reduction in recurrence among patients with non-traumatic strictures (p = 0.005), rural residence (p = 0.042), and penile strictures (p = 0.021).

Conclusion: Intralesional mitomycin-C significantly reduces the recurrence of anterior urethral strictures following OIU by inhibiting fibroblast proliferation and minimizing scar formation. Its routine use in clinical practice may improve long-term success rates and reduce the need for repeated interventions. Further studies with extended follow-up periods are recommended to establish its long-term efficacy.