The use of local therapy in preventing urethral strictures: A systematic review

Background Urethral stricture disease is a common problem amongst men in Western countries often leading to a decreased quality of life. Current endoscopic treatment procedure shows an unsatisfying stricture recurrence rate which could be improved by addition of local therapies. Objectives To provide an overview of both preclinical and clinical studies in order to investigate current level of evidence on the addition of local therapy to improve urethral stricture recurrence rates after endoscopic procedures. Methods We performed a literature search in December 2020 and August 2021 using Cochrane, Embase, PubMed, Scopus and Web of Science and identified articles through combinations of search terms for ‘urethral stricture disease’, ‘stricture formation’ and ‘local interventions’. We used the SYRCLE, RoB-2 and ROBINS-I tools to assess risk of bias across included studies. We did not perform a meta-analysis due to methodological differences between studies. Results We included 32 articles in the qualitative analysis, 20 of which were preclinical studies and 12 clinical studies. Regarding preclinical articles using an animal model, nearly all interventions showed to have a positive effect on either urethral fibrosis, urethral stricture formation and/or fibrotic protein expression levels. Here, immunosuppressants and chemotherapeutics seemed most promising for possible clinical purposes. Regarding clinical studies, mitomycin-C and hyaluronic acid and carboxymethylcellulose showed positive effects on urethral stricture recurrence rates with low to intermediate risk of bias across studies. However, the positive clinical effects of mitomycin-C and steroids seemed to decrease in studies with a longer follow-up time. Conclusion Although local adjuvant use of mitomycin-C or hyaluronic acid and carboxymethylcellulose may carry clinical potential to improve urethral structure recurrence rates after endoscopic procedures, we believe that a large, well-designed RCT with a yearlong follow-up time is necessary to identify the true clinical value.

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European Association of Urology Guidelines on Urethral Stricture Disease (Part 2): Diagnosis, Perioperative Management, and Follow-up in Males

European Urology ◽

10.1016/j.eururo.2021.05.032 ◽

2021 ◽

Author(s):

Felix Campos-Juanatey ◽

Nadir I. Osman ◽

Tamsin Greenwell ◽

Francisco E. Martins ◽

Silke Riechardt ◽

...

Keyword(s):

Urethral Stricture ◽

European Association ◽

Perioperative Management ◽

Urethral Stricture Disease ◽

European Association Of Urology

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Urethro-cavernosal-spongiosal fistula after intralesional mitomycin C for recurrent urethral stricture disease

Urology Case Reports ◽

10.1016/j.eucr.2020.101281 ◽

2020 ◽

Vol 33 ◽

pp. 101281 ◽

Cited By ~ 1

Author(s):

Peter Rehder ◽

Marco Pedrini ◽

Lukas Andrius Jelisejevas ◽

Alexandra Gulacsi ◽

Wolfgang Horninger ◽

...

Keyword(s):

Mitomycin C ◽

Urethral Stricture ◽

Urethral Stricture Disease

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Effect of Mitomycin C on Anterior Urethral Stricture Recurrence after Internal Urethrotomy

European Urology ◽

10.1016/j.eururo.2006.11.038 ◽

2007 ◽

Vol 51 (4) ◽

pp. 1089-1092 ◽

Cited By ~ 78

Author(s):

Hamid Mazdak ◽

Iraj Meshki ◽

Fatemeh Ghassami

Keyword(s):

Mitomycin C ◽

Urethral Stricture ◽

Internal Urethrotomy ◽

Stricture Recurrence

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Radial incision and cutting combined with balloon dilation for refractory pancreaticojejunostomy anastomotic strictures

Endoscopy International Open ◽

10.1055/a-1372-3628 ◽

2021 ◽

Vol 09 (04) ◽

pp. E578-E582

Author(s):

Tadahisa Inoue ◽

Mayu Ibusuki ◽

Rena Kitano ◽

Yuji Kobayashi ◽

Tomohiko Ohashi ◽

...

Keyword(s):

Clinical Success ◽

Anastomotic Stricture ◽

Balloon Dilation ◽

Recurrence Rates ◽

Pancreatic Stone ◽

Radial Incision ◽

Anastomotic Strictures ◽

The Mean ◽

Stricture Recurrence

Abstract Background and study aims Endoscopic balloon dilation (BD) and temporary stent placement for pancreaticojejunostomy anastomotic stricture (PJAS) achieves good short-term outcomes; however, stricture recurrences remain frequent. We examined the feasibility of performing radial incision and cutting (RIC) combined with BD for refractory PJAS. Patients and methods Five consecutive patients with refractory PJAS who underwent RIC with BD between 2015 and 2018 were retrospectively investigated. We evaluated the technical and clinical success, adverse event (AE), and recurrence rates associated with RIC with BD. Results In all five patients, technical and clinical success were achieved. Pancreatic stone removal was simultaneously performed in one patient. The mean procedure time was 18 minutes (range 12–23 minutes). There were no procedure-related AEs. All patients were followed for over 2 years, with a mean follow-up period of 33 months (range 24–40 months). During the follow-up period, none of the patients developed stricture recurrence and all anastomoses remained patent. Conclusions This is the first report of RIC with BD for the treatment of refractory PJAS, showing favorable results. This combined procedure might be a useful option for treating refractory PJAS.

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A comparative evaluation of conjunctival autograft and intra- operative mitomycin-C in the management of primary pterygium- our experience

International Surgery Journal ◽

10.18203/2349-2902.isj20171617 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1866

Author(s):

Satish D. Shet ◽

Piyush S. Gupta

Keyword(s):

Mitomycin C ◽

Tertiary Care ◽

Care Hospital ◽

Recurrence Rates ◽

Tropical Country ◽

Conjunctival Autograft ◽

Pterygium Surgery ◽

Comparative Prospective Study ◽

Primary Pterygium

Background: Surgery is the treatment of choice in the management of primary pterygium. Recurrence following excision is frustrating to both the surgeons and patients alike. India being a tropical country is an ideal home for pterygium.Methods: This study was carried out in a tertiary care hospital. A comparative prospective study was performed in 80 patients presenting with primary pterygium who fulfill inclusion and exclusion criteria were taken for the study for the period from January 2011 to December 2012. They were randomised in two equal groups to undergo primary pterygium surgery with conjunctival autograft and excision of primary pterygium followed by intraoperative use of Mitomycin-C for 3 minutes to study the effectiveness of adjuncts i.e. mitomycin -C and conjunctival autograft in preventing recurrence of pterygium after excision and complications following the procedure. Follow up visits were scheduled for the postoperative days 1, 7, 30 days and 3 and 6 months. mean follow up was for 9 months.Results: No significant intra operative complications were noted except for 2 cases of button holing of the conjunctival graft. Recurrence was noted in 1 case after conjunctival autograft and 1 case in mitomycin C group.Conclusions: The adjuncts in primary pterygium surgery as conjunctival autograft and pterygium excision with mitomycin-C significantly reduces the recurrence rates than bare sclera excision alone.

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[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

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A report on the clinical efficacy of a new Bougie-internal urethrectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.2751 ◽

2015 ◽

Vol 9 (7-8) ◽

pp. 447 ◽

Cited By ~ 1

Author(s):

Choe Sung Hyn ◽

Kim Han Jong ◽

Choe Un Chol

Keyword(s):

Clinical Efficacy ◽

Urethral Stricture ◽

Endoscopic Treatment ◽

Internal Urethrotomy ◽

Recurrence Rates ◽

Flow Rates ◽

Urethral Stricture Disease ◽

Endoscopic Urethrotomy ◽

Group 2 ◽

Group 1

Introduction: We compare the clinical efficacy of the new bougieinternal urethrectomy (BIU) with internal urethrotomy and urethroplasty to treat urethral stricture disease. Methods: We prospectively studied 186 people with urethral stricture disease. Of these, 84 were identified for urethroplasty and 102 for internal urethrotomy (endoscopic urethrotomy). Among the 84 identified for urethroplasty, 52 received BIU (Group 1) and the remaining 32 received urethroplasty. Among the 102 identified for internal urethrotomy, 58 received BIU (Group 2) and the remaining 44 received the internal urethrotomy. After surgery, we evaluated the clinical efficacy of the BIU (operative invasions, voiding flow rates, complications, sequelae) compared with the endoscopic treatment and urethroplasty.Results: Patient age ranged from 20 to 70 years. The follow-up period was 2 years. In the BIU Group 1, the BIU Group 2, and the internal urethrotomy (endoscopic treatment), the length of strictures were 2.9 ± 1.5, 2.8 ± 1.3, 1.6 ± 0.7, and 1.5 ± 0.6, respectively. In the BIU Group 1, the urethroplasty, the BIU Group 2, and the internal urethrotomy (endoscopic treatment), the amount of bleeding was 34.1 ± 17.1, 172.2 ± 29.8, 28.5 ± 9.8, and 49.7 ± 13.6 mL, respectively. In the BIU Group 1, the urethroplasty, the BIU Group 2, and the internal urethrotomy, the recurrence rates were 5.8%, 86%, 6.8% and 25%, and the average flow rates were 18.1 ± 4.8, 13.1 ± 3.9, 18.2 ± 3.6, 10.1 ± 3.1 mL/s, respectively. There was no sequealae (sexual dysfunction, penile change) in both BIU groups.Conclusions: The new BIU could be considered first-line treatment in all patients with indications for visual internal urethrotomy and urethroplasty.

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