LAUSR

Objective To evaluate the efficacy of transurethral intralesional injection of mitomycin C (MMC) during visual internal urethrotomy in decreasing the recurrence rate of urethral stricture, as direct visual urethrotomy is a common endoscopic procedure for short bulbar urethral strictures but one of the major drawbacks of this procedure is stricture recurrence. Methods In this prospective, controlled, randomised study, from December 2015 to April 2018, 55 patients with symptomatic urethral stricture (primary or secondary) were included. Diagnosis of stricture was confirmed by history taking, physical examination, abdominal ultrasonography, uroflowmetry, and retrograde urethrography. In all, 27 patients were treated by visual internal urethrotomy alone, and 28 by visual internal urethrotomy followed by intralesional injection of MMC. The preoperative data recorded in both groups included: patient age, length of stricture, aetiology of stricture, presentation of patients, and maximum urinary flow rate (Qmax).The postoperative data recorded included: Qmax, postoperative complications, and incidence and timing of stricture recurrence during the follow-up period. Results All preoperative data were comparable in both groups, without statistically significant differences. The mean age of the patients was 39.6 years in the MMC group and 42.8 years in the control group, the mean length of the stricture was 9.4 mm in the MMC group and 9.1 mm in the control group. Postoperative improvement in Qmax was highly significant in both groups. Postoperative complications were minimal and comparable in both groups. The stricture recurrence rate was significantly lower in the MMC group (P = 0.021), and occurred 1 year after the operation. Conclusion The adjuvant use of transurethral intralesional injection of MMC at the time of visual urethrotomy for short bulbar urethral strictures is a safe and highly effective procedure in reducing the stricture recurrence rate and in delaying the time for such recurrence.