Efficacy of Optical Internal Urethrotomy and Intralesional Injection of Vatsala-Santosh PGI Tri-Inject (Triamcinolone, Mitomycin C, and Hyaluronidase) in the Treatment of Anterior Urethral Stricture

Purpose. To study the efficacy of optical internal urethrotomy with intralesional injection of Vatsala-Santosh PGI tri-inject (triamcinolone, mitomycin C, and hyaluronidase) in the treatment of anterior urethral stricture.Material and Methods. A total of 103 patients with symptomatic anterior urethral stricture were evaluated on the basis of clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with optical internal urethrotomy followed by injection of tri-inject at the urethrotomy site. Tri-inject was prepared by diluting the combination of triamcinolone 40 mg, mitomycin C 2 mg, and hyaluronidase 3000 in 5–10 mL of saline according to length of stricture. An indwelling 18 Fr silicone catheter was left in place for a period of 7–21 days. All patients were followed up for 6–18 months postoperatively on the basis of history, uroflowmetry, and, if required, retrograde urethrogram and micturating urethrogram every 3 months.Results. The overall recurrence rate after first OIU is 19.4% (20 out of 103 patients), that is, a success rate of 80.6%. Overall recurrence rate after second procedure was 5.8% (6 out of 103 patients), that is, a success rate of 94.2%.Conclusion. Optical internal urethrotomy with intralesional injection of Vatsala-Santosh PGI tri-inject (triamcinolone, mitomycin C, and hyaluronidase) is a safe and effective minimally invasive therapeutic modality for short segment anterior urethral strictures.

Download Full-text

Efficacy of Mitomycin C Combined with Direct Vision Internal Urethrotomy for Urethral Strictures: A Systematic Review and Meta-Analysis

Urologia Internationalis ◽

10.1159/000518977 ◽

2021 ◽

pp. 1-14

Author(s):

Chunru Xu ◽

Zhenpeng Zhu ◽

Lanruo Lin ◽

Tongde Lv ◽

Tianyu Cai ◽

...

Keyword(s):

Success Rate ◽

Mitomycin C ◽

Recurrence Rate ◽

Urethral Stricture ◽

Risk Of Bias ◽

Internal Urethrotomy ◽

Randomized Controlled ◽

Urethral Strictures ◽

Posterior Urethra

Background: The high recurrence of a urethral stricture after direct vision internal urethrotomy (DVIU) has been a problem for years. Mitomycin C (MMC) is an excellent antifibrosis antigen that has been used in many fields, but its effect on a urethral stricture remains controversial. The purpose of this review was to investigate the effectiveness of MMC in reducing the recurrence rate of a urethral stricture after the first urethrotomy. Methods: Common databases were searched for publications prior to November 30, 2020. Randomized controlled and cohort trials were all included. Recurrence and success rates after the first urethrotomy of the posterior urethra were the main outcomes. Revman 5.3 was used for statistical analysis. Two evaluation systems, the Cochrane risk of bias tool and the Newcastle Ottawa Scale, were used to examine the risk of bias for RCTs and all studies. The quality of evidence was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation standard. Results: Sixteen trials were included, the reporting quality of which was generally poor, and the evidence level was very low to moderate. The addition of MMC could significantly reduce the recurrence rate of urethral strictures (risk ratio [RR] = 0.42; 95% confidence interval [CI]: 0.26, 0.67; p = 0.0002; 9 trials; 550 participants). The results of the subgroup analysis suggested that the effect of MMC combined with DVIU was significant in short (≤2 cm) anterior urethral strictures (RR = 0.39; 95% CI: 0.20, 0.78; p = 0.008), >12-month follow-up (RR = 0.45; 95% CI: 0.26, 0.76; p = 0.003). It also increased the success rate of the first urethrotomy procedure for posterior urethral contracture (RR = 0.74; 95% CI: 0.65, 0.84; p < 0.00001; 7 trials; 342 participants). Low-dose local injection of MMC was the most commonly used method. Conclusion: MMC combined with DVIU is a promising way to reduce the long-term recurrence rate of a short-segment anterior urethral stricture. It also increases the success rate of the first urethrotomy of the posterior urethra. However, more high-quality randomized controlled trials are needed.

Download Full-text

To Compare the Recurrence Rate of Strictures after Internal Optical Urethrotomy with Intralesional Injection of Mitomycin C versus without Mitomycin C Injection in Patients Presenting with Anterior Urethral Stricture

10.53350/pjmhs2115102856 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2856-2858

Author(s):

Ismat Ullah ◽

Muhammad Waqar Shahid ◽

Muhammad Azeem Mughal ◽

Rahat Usman

Keyword(s):

Mitomycin C ◽

Recurrence Rate ◽

Urethral Stricture ◽

Controlled Trial ◽

P Value ◽

Intralesional Injection ◽

Corpus Spongiosum ◽

Indwelling Catheter ◽

Significant Difference ◽

The Mean

Background: The urethral strictures occurred due to narrowing of urethra. These may occur after an injury or ureteral or excretory system diseases, due to the injury to urothelium or corpus spongiosum that lead to the development of scar tissues. Mitomycin C can be used as chemotherapeutic agent because of its quality of being anti-tumour actions. Aim: To compare the recurrence rate of strictures after internal optical urethrotomy with intralesional injection of Mitomycin C versus without Mitomycin C injection in patients presenting with anterior urethral stricture. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Urology, Lahore General Hospital, Lahore from 5th September 2016 to 5th March 2017. Methodology: Sixty male patients age 18-70 years, diagnosed with anterior (penile and bulbar) urethral stricture up to 2.0cm were included. Patients were randomly divided into two groups; Group A patients were treated with internal optical urethrotomy alone and Group B patients treated with internal optical urethrotomy with intralesional injection of Mitomycin C. After the procedure, an 18F or 20F indwelling catheter left for 7 days. After 6 months, surgical site evaluated and if stricture again developed, then recurrence labeled. Results: The mean age was 39.32±11.38 years, mean duration of stricture was 6.85±3.32 months and the mean stricture size was 1.21±0.45 cm. The recurrence occurred in 18 (30%) patients. Significant difference was noted for recurrence in both groups (p-value<0.05). Conclusion: The recurrence rate with anterior urethral stricture is significantly lower in with Mitomycin C as compared to without Mitomycin C. Keywords: Recurrence, Urethral stricture, Mitomycin C

Download Full-text

Treatment of Short Segment Anterior Urethral Stricture: Optical Internal Urethrotomy (OIU) Alone and OIU with Triamcinolone

Bangladesh Medical Journal ◽

10.3329/bmj.v48i1.50189 ◽

2019 ◽

Vol 48 (1) ◽

pp. 31-38

Author(s):

Mohammad Humayun Kabir Bhuiyun ◽

Abu Masud Al Mamun ◽

Towhid Belal ◽

Rezawanul Haque Rabbani ◽

Md Khairul Islam ◽

...

Keyword(s):

Triamcinolone Acetonide ◽

Urethral Stricture ◽

Therapeutic Modality ◽

Control Group ◽

Internal Urethrotomy ◽

Triamcinolone Injection ◽

Group A ◽

Group B ◽

Optical Internal Urethrotomy

Optical urethrotomy has been considered standard therapy for anterior urethral stricture since its introduction in 1976. Now optical internal urethrotomy (OIU) with intralesional triamcinolone injection is a safe and effective, minimally invasive therapeutic modality. The aim of the study is to compare the outcome of OIU alone and OIU with intralesional triamcinolone injection in the treatment of anterior urethral stricture. This Quasi Experimental study was carried out among 50 male patients with bulbar urethral stricture in the Department of Urology, Dhaka Medical College Hospital, Dhaka, over a period of six months. The age range of the patients were 32-46 years and patients were divided equally into two groups, OIU with and without intralesional triamcinolone acetonide injection as Group- A (experimental group, 25 patients) and Group- B (control group, 25 patients). Post-operative evaluation was done on the basis of history and uroflowmetry. Retrograde urethrography and micturating cystourethrography were done only in patient who developed obstructive voiding problems or flow rate below 10 ml/second. Follow up was done at regular interval on 7th day, 3rd month and 6th month. Post-operative outcomes were compared between two groups. Post-operative infection was significantly higher among those OIU with intralesional Triamcinolone acetonide injection (8%) than patients without intralesional Triamcinolone acetonide injection (4%). Per operative extravasations of urine were significantly higher among those without intralesional Triamcinolone acetonide injection (4%) than subjects with intralesional Triamcinolone acetonide injection. Extravasation not influenced by steroid but this patient subsequently suffered recurrence of stricture. In Group-A, pre and post-operative Q-max were 10.25±2.21 and 22.11±2.96 ml/sec respectively. In Group-B, pre and post-operative follow up Q-max were 10.37±2.55 and 19.54±2.65 mi/sec respectively. In Group-A, pre and post-operative voiding time was 85.20±4.20 and 27.10±3.36 sec respectively. In Group-B, pre and post-operative follow up voiding time were 86.37±4.55 and 31.45±2.55 sec respectively. Post-operative recurrences of stricture were significantly higher among those without intralesional Triamcinolone acetonide injection (24%) than subjects with intralesional Triamcinolone acetonide injection (12%). Post-operative it seems that triamcinolone injection after OIU is safe method to prevent the recurrence of urethral stricture Bangladesh Med J. 2019 Jan; 48 (1): 31-38

Download Full-text

Results of Buccal Mucosal Graft Urethroplasty in Management of Anterior Urethral Stricture – Experience in a Single Center

Bangladesh Journal of Urology ◽

10.3329/bju.v22i2.50098 ◽

2020 ◽

Vol 22 (2) ◽

pp. 128-131

Author(s):

Mohammad Abdul Aziz ◽

Shafiqur Rahman ◽

Mirza Mahbubul Hasan

Keyword(s):

Success Rate ◽

General Hospital ◽

Urethral Stricture ◽

Buccal Mucosa ◽

Single Center ◽

Internal Urethrotomy ◽

Exclusion Criteria ◽

Urethral Strictures ◽

Buccal Mucosal Graft ◽

Optical Internal Urethrotomy

Objective: To share our experience with buccal mucosal graft (BMG) urethroplasty for the management of anterior urethral strictures in BIRDEM General Hospital, Dhaka. Materials and methods: This study was conducted from January 2013 to January 2018. Patients selected according to inclusion and exclusion criteria. The oral mucosal characteristics were assessed in all patients during the initial workup. Single stage dorsolateral onlay graft urethroplasty done in all patients. They were followed according schedule for outcome and complications. Result:Total 59 patients were studied. Overall success rate of BMG urethroplasty was 88.1% at 12th month. Complications include development of periurethral abscess (3.4%), restructure (8.5%) development of fistula (1.7%). Total 8 patients underwent retreatment procedures like drainage of periurethral abscess, dilatation, optical internal urethrotomy (OIU) and revision urethroplasty. Conclusion:The buccal mucosa is easy to obtain and handle, therefore BMG urethroplasty is a safe and effective in managing anterior urethral stricture. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.128-131

Download Full-text

[15] The role of mitomycin C intralesional injection during visual internal urethrotomy in urethral stricture recurrence

Arab Journal of Urology ◽

10.1016/j.aju.2018.10.062 ◽

2018 ◽

Vol 16 (sup1) ◽

pp. S8-S9

Author(s):

Issam Al Azzawi

Keyword(s):

Mitomycin C ◽

Urethral Stricture ◽

Intralesional Injection ◽

Internal Urethrotomy ◽

Stricture Recurrence

Download Full-text

Outcome Between Intralesional Injection of Triamcinolone following Optical Internal Urethrotomy (OIU) and OIU Alone for the Management of Short Segment Stricture of male Urethra

Journal of Dhaka Medical College ◽

10.3329/jdmc.v29i2.51186 ◽

2021 ◽

Vol 29 (2) ◽

pp. 126-130

Author(s):

Md Sazzad Hossain ◽

Mir Ehteshamul Haque ◽

Mohammad Zahid Hasan ◽

Prodyut Kumar Saha ◽

Mostafiger Rahman ◽

...

Keyword(s):

Urethral Stricture ◽

Statistical Tests ◽

Time Interval ◽

Intralesional Injection ◽

Internal Urethrotomy ◽

Short Segment ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Optical Internal Urethrotomy

Objective: To compare the outcome of optical internal urethrotomy (OIU) with or without intralesional triamcinolone acetonide injection for the treatment of short segment anterior urethral stricture. Methods: This prospective quasi experimental study was carried out in the department of Urology, DMCH, Dhaka from November 2015 to April 2017 on 50 patients with short segment of anterior urethral stricture. Cases were randomly allocated to group A (OIU without Triamcinolone) and group B (OIU with Triamcinolone). Each group consisted of 25 patients. Data were analyzed and compared by statistical tests. Results: There were no significant differences in the baseline characteristics of the patients. Recurrences of stricture urethra were higher among those without Triamcinolone than cases with Triamcinolone which was statistically significant (p=0.033) at 6 month and (p=0.016) at 9 months. Regarding mean time interval in month of development of recurrence of stricture was 6.1±1.66 months in Group A and 7.66±1.52 months in Group B which was statistically significant (p=0.001) Conclusion: OIU with intralesional triamcinolone is better than OIU alone. It significantly reduced and delayed the recurrence of anterior urethral stricture. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 126-130

Download Full-text

The Effects of Hyaluronic Acid in Preventing Recurrence of Urethral Stricture after Visual Internal Urethrotomy

QJM ◽

10.1093/qjmed/hcaa070 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

H H G Hasan ◽

M K A Tolba ◽

M M M Shalaby

Keyword(s):

Hyaluronic Acid ◽

Recurrence Rate ◽

Urethral Stricture ◽

Large Scale ◽

Control Group ◽

Urethral Reconstruction ◽

Internal Urethrotomy ◽

Randomized Controlled ◽

Voiding Symptoms ◽

Number Of Patients

Abstract Background Many urologists prefer Visual internal urethrotomy (VIU)because of its ease to perform, short hospital stay, low cost, and perceived low complication rate. They may repeat VIU several times to avoid complex urethral reconstruction, because it requires significant surgical experience. Because of its effectiveness and simplicity, VIU is the primary treatment option for urethral stricture disease. However, the recurrence rate is high and the success rate is low. Aim of the Work To evaluate the effect of hyaluronic acid (HA) instillation during visual internal urethrotomy (VIU) for decreasing the incidence of recurrent urethral stricture. Patients and Methods A total of 50 patients who were treated by Visualized internal uretherotomy for urethral stricture between February 2017 and January 2019 were invited to participate in the present study. This study is a multicenter,prospective, randomized controlled, single-blinded study. Results In this study the experimental group had a better voiding symptoms than the control group six months after the surgery,The present study showed that the instillation of hyaluronic acid into the urethra during visualized internal urethrotomy didn’t significantly reduced the recurrence of urethral stricture after the operation although the number of patients who had recurrence after hyaluronic acid instillation were less than recurrence rate in the control group. The hyaluronic acid had no observed side effects and helped to improve the pain and quality of life after the surgery. Conclusion The instillation of hyaluronic into the urethra during VIU reduced postoperative pain and improved voiding symptoms in the study group , but it didn’t significantly reduce the recurrence of urethral stricture after the operation. we suggest that a large-scale, randomized controlled trial be conducted in a larger number of patients with long-term follow-up .

Download Full-text

Dorsolateral Onlay Urethroplasty for the Long Segment Anterior Urethral Stricture: Outcome of 31 Cases

Bangladesh Journal of Urology ◽

10.3329/bju.v18i1.49203 ◽

2020 ◽

Vol 18 (1) ◽

pp. 12-15

Author(s):

Hafiz Al Asad ◽

Md Sharif Shahjamal ◽

Sarforaj Ali Khan ◽

Md Waliul Islam ◽

AKM Zamanul Islam Bhuiyan

Keyword(s):

Urethral Stricture ◽

Kidney Diseases ◽

Successful Outcome ◽

Anastomotic Site ◽

Short Term ◽

Buccal Mucosa Graft ◽

Retrograde Urethrogram ◽

A Prospective Study ◽

Optical Internal Urethrotomy

Objective: This study is designed to observe the short-term outcomes of dorsolateral onlay urethroplasty to treat long segment anterior urethral stricture. Materials and Methods: A prospective study from May 2011 to September 2012 is carried out in department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBanglanagar, Dhaka. Thirty one patients with long anterior urethral stricture were treated by a dorsolateral onlay buccal mucosa graft. After voiding trial, they were followed up at 3 weeks and 3 months with history, physical examination, uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry <15 ml/sec). Patients were further followedup at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry <15 ml/sec). Successful outcome was defined as normal voiding with no surgical intervention after catheter removal. Results: Mean stricture length was 42.49±12.77 mm (range 24-70 mm) and mean follow up was 8 months (range 6 to 12 months). Three patients were found to develop stricture at anastomotic site, during follow-up and required optical internal urethrotomy and was considered as failure. One patient developed wound infection which resolved after regular dressing. Success rate was 90.32%. Conclusion: Dorsolateral onlay BMG urethroplasty is feasible for long anterior urethral stricture with good short term surgical outcome. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.12-15

Download Full-text

Internal urethrotomy versus plasmakinetic energy for surgical treatment of urethral stricture

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2015.2.161 ◽

2015 ◽

Vol 87 (2) ◽

pp. 161 ◽

Cited By ~ 1

Author(s):

Levent Ozcan ◽

Emre Can Polat ◽

Alper Otunctemur ◽

Efe Onen ◽

Oğuz Ozden Cebeci ◽

...

Keyword(s):

Surgical Treatment ◽

Urethral Stricture ◽

Maximum Flow ◽

Clinical History ◽

Internal Urethrotomy ◽

Urethral Strictures ◽

Cold Knife ◽

Group 2 ◽

Stricture Recurrence ◽

Group 1

Purpose: we aimed to compare the longterm outcome of surgical treatment of urethral stricture with the internal urethrotomy and plasmakinetic energy. Material and Methods: 60 patients, who have been operated due to urethral stricture were enrolled in our clinic. None of the patients had a medical history of urethral stricture. The urethral strictures were diagnosed by clinical history, uroflowmetry, ultrasonography and urethrography. The patients were divided two groups. Group 1 consisted of 30 patients treated with plasmakinetic urethrotomy and group 2 comprised 30 men treated with cold knife urethrotomy. Results: There were no statistically significant differences between two groups in terms of patient age, maximum flow rate (Qmax) and quality of life score (Qol) value. A statistical difference between the two groups was observed when we compared the 3rd-month uroflowmetry results. Group 1 patients had a mean postoperative Qmax value of 16,1 ± 2,3 ml/s, whereas group 2 had a mean postoperative Qmax value of 15,1 ± 2,2 ml/s (p < 0.05). In the cold knife group, 3 of 11 (27,7%) recurrences appeared within the first 3 months, whereas in the plasmakinetic group zero recurrences appeared within the first 3 months in our study. The urethral stricture recurrence rate up to the 12 month period was statistically significant for group 1 (n = 7, 23%) compared with group 2 (n = 11, 37%) (p < 0.05). Conclusion: We believe that plasmakinetic surgery is better method than the cold knife technique for the treatment of urethral stricture.

Download Full-text

Evaluation of Holmium Laser versus Cold Knife in Optical Internal Urethrotomy for the Management of Urethral Stricture

QJM ◽

10.1093/qjmed/hcab110.014 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Wael Ali Maged ◽

Mohamed Ahmed Gamal ◽

Samuel Fayek Tawfeles

Keyword(s):

Urethral Stricture ◽

Treatment Effectiveness ◽

Holmium Laser ◽

Military Hospital ◽

University Hospitals ◽

Internal Urethrotomy ◽

Cold Knife ◽

Group 10 ◽

Optical Internal Urethrotomy

Abstract Background : urethral stricture is one of the most difficult urological problems to cure adequately and is know to mankind since ages as it has been documented in ancient literature of Egyptians and Greeks. Aim of the work: the aim of our study is to evaluate and compare the outcomes of Ho:YAG laser urethrotomy with the conventional cold knife technique as regards treatment outcome, efficacy and complications Patients and methods: A total of 20 male patients presented to the urology department at El Maadi military hospital and Ain shams university hospitals diagnosed as urethral stricture requiring optical internal urethrotomy were included in this study. Patients were randomized into two groups : In group A (holmium group): 10 patients underwent internal urethrotomy with Holmium laser. In group B (cold knife group) 10 patients underwent internal urethrotomy with cold knife. Results: based upon uroflowmetry, assessment of treatment effectiveness and complications were made at 3 months follow-up. Post operative fall in the peak flow rate was noted during the follow up in both groups, but was highter fall in the holmium group than the cold knife group at the end of the third month.

Download Full-text