The Effectiveness of Tamoxifen in the Prevention of Recurrent Urethral Strictures Following Internal Urethrotomy

Abstract

Objective: Tamoxifen was not used earlier in clinical practice to decrease the urethral re-stricture rate after visual internal urethrotomy (VIU). In this study, we are the first to report the use of Tamoxifen as an adjuvant therapy to decrease the re-fibrosis and stricture recurrence post-VIU. Patients and Methods: Between 2015 and 2017, 60 patients underwent VIU for post-traumatic bulbar urethral stricture ≤1 cm. They were randomly divided into 2 groups (30 patients each). The Tamoxifen group cases received Tamoxifen 10 mg twice daily for 6 months post-VIU. The control group did not receive any medications. All patients were evaluated using the IPSS score, uroflowmetry, and perineal ultrasonography preoperatively at 3 and 6 months. Results: At presentation, there was no significant difference between patients of both groups in terms of IPSS score, Qmax, stricture width, and length. At 6 months follow-up, the mean IPSS score for the Tamoxifen group was 12.3 (8–19) in comparison with 20 (12–26) in the control group (p < 0.001). The Tamoxifen group had mean Qmax 11.1 mL/s (9–14), while those of the control group had mean Qmax 8.2 mL/s (6–10; p < 0.001). Using perineal ultrasound, only stricture width showed to be significantly smaller in the Tamoxifen group (p = 0.001). Conclusion: Tamoxifen seemed to be effective in reducing the recurrence of urethral stricture post-VIU. There was a significant improvement of the clinical outcome regarding Qmax and IPSS score after Tamoxifen adjuvant therapy.

A Systematic Review and Meta-analysis of Adjuncts to Minimally Invasive Treatment of Urethral Stricture in Men

“…Most studies in the current analysis did not report any significant adjunct-specific complications. Tamoxifen resulted in two (6.7%) patients having mild gynaecomastia (34). Although no significant side effects were reported with mitomycin C in this study, one retrospective study reported two cases of osteitis pubis and one case of rectourethral fistula when injecting mitomycin at the bladder neck for recalcitrant bladder neck stenosis (60).…”

“…Only mitomycin C and local steroids have been studied in more than one RCT. Intraurethral instillation with hyaluronic acid and carboxymethylcellulose (26), PRP (31) and oral tamoxifen (34) have each been studied in single RCTs and the other adjuncts such as brachytherapy (28), captopril (30), paclitaxel-coated balloons (32,33) and oral deflazacort (35) have been evaluated in prospective or retrospective cohort studies.…”

Non-Surgical Treatment of Peyronie’s Disease: A Comprehensive Review

“…Its anti-fibrotic activity has confirmed in several studies. El-Shazly et al showed that tamoxifen effectively prevents the recurrence of urethral stricture after internal urethrotomy and improvement of Qmax and IPSS score compared with the control group [18].In the rat model of Peyronie's disease, Ilg MM, et al demonstrated that the combination of vardenafil and tamoxifen inhibited the myofibroblast transformation and ECM production [19].…”

Pharmacotherapy of urethral stricture

“… 74 75 76 Moreover, TAM has been reported to reduce urethral stricture recurrence after visual IU. 77 …”