UroToday- Multiple variations to the procedure of the direct vision internal urethrotomy (DVIU) have been proposed to increase the efficacy of this procedure which classically has had a poor long-term success rate. The use of lasers, injection of steroids and the addition of post-procedure intermittent self dilation are some of the variations of the technique that have been employed to improve on a long-term success rate which has consistently been less than 50%.

Recently, a prospective randomized controlled trial was performed to evaluate the efficacy of Mitomycin C administered in a submucosal injection after DVIU to decrease the recurrence of stricture. The study by H. Mazdak and colleagues from Isfahan, Iran is published in the April 2007 issue of European Urology.

Forty male patients with anterior urethral strictures were randomized to undergo DVIU with or without urethral submucosal Mitomycin C injection. The Mitomycin C (0.1mg) was injected submucosally at the urethrotomy site in 20 patients. Mean patient age was 29.8 years. Mean stricture length, as measured by retrograde urethrography (RUG) was 0.75 cm. Mean caliber of the stricture, as measured by RUG was 1.25 mm. The patients were re-evaluated after 6 months by RUG and the stricture recurrence rate was compared between the two groups.

Analysis of the results revealed a stricture recurrence rate of 50% in the DVIU only group while the recurrence rate in the Mitomycin C group was only 10%. This difference was statistically different. The mean caliber and length of the recurrences in the Mitomycin group were 1.3 mm and 0.71 cm respectively while the values for the DVIU only group were 1.2 mm and 0.84 cm.

The authors believe that Mitomycin C, and alkylating antineoplastic antibiotic derived from Streptomyces Caespitosus. It acts by inhibiting DNA synthesis by cross-linking DNA between adenine and guanine. It is useful in delaying the healing process by preventing replication of fibroblasts and epithelial cells and inhibiting collagen synthesis. It is also proposed that it can delay wound contraction. The drug has been used to prevent the development of fibrosis after myringotomy and trabeculectomy and has improved the success rate of these procedures. Further studies are indicated to evaluate the long-term success rate of this intervention after DVIU for the treatment of anterior urethral stricture disease.

Mazdak H, Meshki I, Ghassami F, Palminteri E
Eur Urol. 51(4):1089-92, April 2007.

Reported by UroToday Contributing Editor Michael J. Metro, M.D.

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