title: Visual Internal Urethrotomy With Intralesional Mitomycin C and Short-term Clean Intermittent Catheterization for the Management of Recurrent Urethral Strictures and Bladder Neck Contractures.
abstract: OBJECTIVE
  To evaluate our longitudinal experience using visual internal urethrotomy (VIU) with intralesional mitomycin C (MMC) and short-term clean intermittent catheterization (CIC) for urethral strictures and bladder neck contractures (BNC) after failure of endoscopic management.
  
  
  METHODS
  This case series involved review of our prospectively developed database of all men who underwent VIU with MMC and CIC in a standardized fashion for urethral stricture or BNC between 2010 and 2013 at our tertiary care medical center. Etiology was identified as radiation-induced stricture (RIS) or non-RIS and analyzed by stricture location. Cold knife incisions were made in a tri or quadrant fashion followed by intralesional injection of MMC and 1 month of once daily CIC.
  
  
  RESULTS
  All 37 patients previously underwent at least 1 intervention for urethral stricture or BNC before VIU with MMC and CIC. Mean stricture length was 2.0 cm (range, 1-6 cm; standard deviation, 1.0 cm). Over the median follow-up period of 23 months (range, 12-39 months), 75.7% of patients required no additional surgical intervention (RIS, 54.5%; non-RIS, 84.6%; P = .051). In those that did recur, median time to stricture recurrence was 8 months (range, 2-28 months). One patient with recurrence required urethroplasty.
  
  
  CONCLUSIONS
  VIU with MMC followed by short-term CIC provides a minimally invasive and widely available tool to manage complex recurrent urethral strictures (<3 cm) and BNC without significant morbidity. This approach may be most attractive for patients who are poor candidates for open surgery.
authors.affiliation: Department of Urology, Rush University Medical Center, Chicago, IL.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Farrell
authors.affiliation: Department of Urology, Rush University Medical Center, Chicago, IL.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Sherer
authors.affiliation: Department of Urology, Rush University Medical Center, Chicago, IL. Electronic address: drlevine@hotmail.com.
authors.forename: Laurence A
authors.initials: LA
authors.lastname: Levine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003286:Contracture / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D057928:Intermittent Urethral Catheterization / Q000379:methods; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000628:therapy*; D001745:Urinary Bladder Diseases / Q000628:therapy*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D055815:Young Adult
chemical_list: D016685:Mitomycin