title: Radial urethrotomy and intralesional mitomycin C for the management of recurrent bladder neck contractures.
abstract: OBJECTIVE
  We evaluated urethrotomy combined with intralesional injection of the antiproliferative agent mitomycin C for the treatment of severe, recurrent bladder neck contractures after traditional endoscopic management failed. We report our experience with radial urethrotomy and intralesional mitomycin C in patients with recurrent bladder neck contractures.
  
  
  METHODS
  A retrospective review was performed of patients evaluated for severe, recurrent bladder neck contractures between January 2007 and April 2010. All patients had at least 1 prior failed incision of a bladder neck contracture. Tri or quadrant cold knife incisions of the bladder neck were performed followed by injection of 0.3 to 0.4 mg/ml mitomycin C at each incision site.
  
  
  RESULTS
  A total of 18 patients were treated with bladder neck incision and mitomycin C injection. Preoperatively 4 (22%) patients presented with indwelling Foley catheters while 7 (39%) required a dilation schedule. At a median followup of 12 months (range 4 to 26) 13 patients (72%) had a patent bladder neck after 1 procedure, as did 3 (17%) after 2 procedures and 1 after 4 procedures. All of the patients presenting with a prior indwelling urethral catheter or requiring a dilation schedule had a stable, patent bladder neck.
  
  
  CONCLUSIONS
  Management of recurrent bladder neck contractures with radial urethrotomy combined with intralesional mitomycin C resulted in bladder neck patency in 72% of the patients after 1 procedure and in 89% after 2 procedures. Although early results are promising, longer followup and randomized, prospective studies are required to validate these findings.
authors.affiliation: Institute of Urology, Lahey Clinic Medical Center, Burlington, Massachusetts, USA.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Vanni
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Zinman
authors.forename: Jill C
authors.initials: JC
authors.lastname: Buckley
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014521:Urethra / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000188:drug therapy* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
chemical_list: D016685:Mitomycin