Radial urethrotomy and intralesional mitomycin C for the management of recurrent bladder neck contractures.

Abstract

We evaluated urethrotomy combined with intralesional injection of the antiproliferative agent mitomycin C for the treatment of severe, recurrent bladder neck contractures after traditional endoscopic management failed. We report our experience with radial urethrotomy and intralesional mitomycin C in patients with recurrent bladder neck contractures. A retrospective review was performed of patients evaluated for severe, recurrent bladder neck contractures between January 2007 and April 2010. All patients had at least 1 prior failed incision of a bladder neck contracture. Tri or quadrant cold knife incisions of the bladder neck were performed followed by injection of 0.3 to 0.4 mg/ml mitomycin C at each incision site. A total of 18 patients were treated with bladder neck incision and mitomycin C injection. Preoperatively 4 (22%) patients presented with indwelling Foley catheters while 7 (39%) required a dilation schedule. At a median followup of 12 months (range 4 to 26) 13 patients (72%) had a patent bladder neck after 1 procedure, as did 3 (17%) after 2 procedures and 1 after 4 procedures. All of the patients presenting with a prior indwelling urethral catheter or requiring a dilation schedule had a stable, patent bladder neck. Management of recurrent bladder neck contractures with radial urethrotomy combined with intralesional mitomycin C resulted in bladder neck patency in 72% of the patients after 1 procedure and in 89% after 2 procedures. Although early results are promising, longer followup and randomized, prospective studies are required to validate these findings.