Mitomycin-C and urethral dilatation: A safe, effective, and minimally invasive procedure for recurrent vesicourethral anastomotic stenoses

Sourial, Michael; Richard, Patrick O.; Bettez, Mathieu; Jundi, Mazen; Tu, Le Mai

doi:10.1016/j.urolonc.2017.07.031

Cited by 22 publications

(18 citation statements)

References 24 publications

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“…9 A 2017 study of MMC injection into the bladder neck concluded that it is a safe and effective treatment for recurrent VUAS, with a success rate of 86% with no reported adverse events. 14 This is in contrast to the larger 2015 TURNS study, which showed a 75% success rate, but serious adverse events -including osteitis pubis, rectourethral fistula, and bladder neck necrosis; three of these patients required urinary diversion with cystectomy. 15 However, limitations of the TURNS study included the use of various MMC doses and injection techniques, with short-term follow-up.…”

Section: Discussionmentioning

confidence: 80%

Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety

Neu¹,

Vigil²,

Locke³

et al. 2020

CUAJ

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Introduction: We aimed to evaluate the success of bladder neck injections of triamcinolone at the time of transurethral bladder neck incision (BNI) for prevention of recurrent vesicourethral anastomotic stenosis (VUAS) following prostate cancer treatment. Methods: This is a retrospective cohort study examining patients with recurrent VUAS post-RP ± radiation treated with triamcinolone injections at the time of BNI. VUAS was diagnosed by symptoms followed by cystoscopy or urethrography. The outpatient procedures were done under general anesthesia. Cold knife incisions were made at the three, nine, and 12 o’clock BN positions, followed by triamcinolone injections (4 mg/mL) into the three and nine o’clock incision sites. Treatment outcomes were determined with cystoscopy. Results: Eighteen men underwent 25 procedures over a four-year period. Median age at diagnosis of VUAS was 65 (interquartile range [IQR] 61–68); median time to VUAS from RP was eight months (IQR 5–12). Fourteen patients (78%) had radiation treatment. The cohort had 128 unsuccessful VUAS treatments, with a median of five failed treatments per patient (IQR 3–10). Failed treatments included BN dilation, BNI, BN injection of mitomycin C, and urethral stent placement. Success rate after a mean of 16.3 months (standard deviation [SD] 8.1) from the time of triamcinolone injection was 83% (15/18). Six patients went on to have successful incontinence surgery. Five patients (28%) had treatment complications (bleeding, urinary tract infection, pain, and urinary extravasation). The three non-responders are stable and awaiting re-treatment with triamcinolone injection. Conclusions: Triamcinolone bladder neck injections for post-RP VUAS are a useful and safe treatment for recurrent stenosis.

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Section: Discussionmentioning

confidence: 80%

Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety

Neu¹,

Vigil²,

Locke³

et al. 2020

CUAJ

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“…Comparative options such as bladder neck reconstruction have been shown to provide successful management in approximately 60-93% of patients. In addition, bladder neck reconstruction is a major complex procedure and has a significant risk of incontinence, resulting in the need for artificial urinary sphincter insertion [8,9,13]. Furthermore, urinary diversion is also a major procedure which whilst achieving urinary flow results in worse patient satisfaction outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the number of attempts of these treatments, patency rates can vary from 17 to 89% [ 5 – 7 ]. In the case of intractable VUAS, treatment options include injection of mitomycin C with dilation resulting in patency rates of 79% for the first procedure and 86% for a secondary procedure [ 8 ]. Further treatment options include bladder neck reconstruction, with patency rates of 60–80% [ 9 ] or urinary diversion options such as long-term urethral or suprapubic catheters, vesicostomy or ileal conduit formation.…”

Section: Introductionmentioning

confidence: 99%

Management of intractable bladder neck strictures following radical prostatectomy using the Memokath®045 stent

et al. 2019

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The incidence of vesicourethral anastomotic stenosis (VUAS) post radical prostatectomy varies from 1 to 26%. Current treatment can be challenging and includes a variety of different procedures. These range from endoscopic dilations to bladder neck reconstruction to urinary diversion. We investigated a 2-stage endoscopic treatment, using the thermo-expandable Memokath ® 045 bladder neck stent to manage patients with VUAS post radical prostatectomy. We retrospectively reviewed 30 patients, between 2013 and 2017, who underwent a Memokath ® 045 stent insertion following failed primary treatment (dilation and clean intermittent catheterisation) for VUAS. The mean interval time between prostatectomy and Memokath ® 045 stent insertion was 13 months. The mean follow-up time was 3.6 years with all patients having a minimum of 12-month follow-up. All patients had two previous attempts at endoscopic dilatation with or without incision and a trial of clean intermittent catheterisation. During stage 1, the anastomotic stricture is dilated/incised to diameter of 30 Fr, the stricture length is measured, and a catheter is left in situ. One to 2 weeks later, post haemostasis and healing, an appropriately sized Memokath ® 045 stent is inserted. The stent is then removed 1-year post-op. Our series of patients had a median age of 62 (54-72). Most patients (26) had a robot-assisted radical prostatectomy (RARP) or salvage procedure. Results showed improvement in IPSS scores, IPSS quality of life scores, Q max and PVR after the Memokath ® 045 stent was removed compared to pre-operation. With a minimum of 12 months post stent removal, 93% of patients were fully continent, whilst 7% of patients were socially continent. 2 (7%) patients had their stents removed and not replaced due to re-stricturing and stone formation. However, no urinary tract infections, stricture recurrence or urinary retention was observed in the rest of the cohort (93%). Overall, the Memokath ® 045 stent was successful in treating 93% of our patients with VUAS. Our series had minimal complications that were managed with conservative measures and in three patients' re-operation was needed. In conclusion, the Memokath ® 045 stent is a minimally invasive technique with faster recovery time compared to other techniques such as bladder neck reconstruction or urinary diversion. Additionally, it provides superior patency results compared to other techniques such as bladder neck incision and injection of Mitomycin C. Therefore, this management option should be considered in the management of VUAS.

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“…Injection of these three agents increased the effectiveness of internal urethrotomy with no regional or systemic adverse events. Sourial et al (12) performed MMC injection with urethral dilatation for the treatment of recurrent vesicourethral anastomotic stricture after radical prostatectomy and they did not notice any adverse effects. They found that MMC injection with urethral dilatation was a reliable, efficient, and minimally invasive treatment method.…”

Section: Discussionmentioning

confidence: 99%

Scrotal Tissue Necrosis in a Patient with Urethral Stricture Treated with Internal Urethrotomy and Mitomycin-C Injection

Topuz¹,

Yılmaz²,

Uguz³

et al. 2018

jus

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Öz IntroductionUrethral strictures are one of the most difficult urological problems in terms of treatment. Trauma and iatrogenic factors are more frequently observed in the etiology (1). Various treatment techniques have been developed for the treatment of urethral stricture, depending on the length of the stenosis, location and depth of scarring (2). According to the International Consultation on Urological Diseases and American Urological Association Guidelines, simple urethral dilatation, direct visual internal urethrotomy, laser urethrotomy, anterior urethral stenting or urethroplasty can be performed for bulbar urethral strictures of <2 cm (3,4). Urethral dilatation and cold knife urethrotomy are the safest therapy procedures for short urethral strictures, with a total success rate of 35-70% (3). The success rate for this treatment is very low when the size of the stenotic segment is longer than 2 cm (3). Urethral catheter can be safely removed within 24-72 hours following direct visual internal urethrotomy. Surgeons may offer self-catheterization schedules after direct visual internal urethrotomy for maintaining temporary urethral patency in candidates for urethoplasty (3). The success rate for resection and primary anastomosis of Seksen dokuz yaşında erkek hasta skrotal bölgede açık yara ile başvurdu. Skrotal bölgeden anal bölgeye doğru uzanan yaklaşık 4x4 cm'lik nekrotik doku izlendi. Dokuz yıl önce radikal prostatektomi olduğu ve sonra üretra darlığı nedeniyle internal üretrotomi olduğu öğrenildi. Üretroskopisinde 2 cm uzunluğunda anterior üretral darlık saptandı. İnternal üretrotomi sonrası, 20 mg mitomisin-C (MMC), 50 cc salinle dilüe edildi ve intralezyonel (10 cc) ve instilasyon (40 cc) tarzında uygulandı. Önceki uygulamalarda hastalar bu tedaviyi iyi tolere etmişlerdi. Bu olgu sunumunda, internal üretrotomi ve intralezyonel MMC uygulanan bir hastadaki skrotal doku nekrozunu ve tedavisini sunduk.

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Mitomycin-C and urethral dilatation: A safe, effective, and minimally invasive procedure for recurrent vesicourethral anastomotic stenoses

Cited by 22 publications

References 24 publications

Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety

Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety

Management of intractable bladder neck strictures following radical prostatectomy using the Memokath®045 stent

Scrotal Tissue Necrosis in a Patient with Urethral Stricture Treated with Internal Urethrotomy and Mitomycin-C Injection

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