Faculty Opinions recommendation of Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS Study Group.
Bladder neck contractures most commonly occur after transurethral resection of the prostate (TURP) and are distinct from post prostatectomy anastomotic stenosis. The incidence is between 0.9% and 17% {1-3}. These contractures are often initially managed with dilation or urethrotomy and even with transurethral resection (TURBNC). When they are recurrent, radial urethrotomy and the injection of mitomycin C (MMC) has been shown to yield a long-term success rate of 72% for one treatment and 89% after two treatments {4}, while similar success rates have been reported for initial treatment when using bipolar incisions when compared to “cold” urethrotomy {5}. Ali et al. found that the use of MMC decreased the stricture recurrence and increased the time to recurrence in urethral strictures after direct visualization internal urethrotomy (DVIU) {6}. Interestingly, this study—which reports the results from the Trauma and Urologic Reconstruction Network of Surgeons (TURNS)—has similar success rates (~75%), but also reports severe complications in 7% of patients. However, in this series, the dose of MMC was not standardized and often much higher doses than suggested by Buckley et al. {4}. This Recommendation is of an article referenced in an F1000 Faculty Review also written by Maxx A. Gallegos and Richard A. Santucci.