#0470

Outcome of Intralesional Mitomycin C with Optical Internal Urethrotomy and Optical Internal Urethrotomy with Clean Intermittent Self Catheterization in the Treatment of Bulbar Urethral Stricture

D. Shovon¹, D. Morshed², D. Alam³, D. Arefin⁴, M. Al Nury⁵, D. Mostofa⁶, D. Hasan¹, D. Tasnim⁷

¹Sir Salimullah Medical College Hospital, Urology, Dhaka, Bangladesh
²Dhaka Medical College Hospital, Urology, Dhaka, Bangladesh
³Mymensingh medical college Hospital, Urology, Mymensingh, Bangladesh
⁴Shaheed Suhrawardy Medical College & Hospital, Urology, Dhaka, Bangladesh
⁵Faridpur Medical College Hospital, Urology, Faridpur, Bangladesh
⁶Rajshahi Medical College Hospital, Urology, Rajshahi, Bangladesh
⁷National Institute of Ophthalmology & Hospital, Dhaka, Ophthalmology, Dhaka, Bangladesh

Introduction:

Urethral stricture is one of the oldest known urological diseases and remains a common problem with high morbidity. The most common kind of management for urethral stricture is optical internal urethrotomy (OIU) which is a minimally invasive procedure with lower morbidity. But there is a common postoperative complication after OIU, recurrence of stricture. To prevent this, several methods have been added with this therapeutic option like, injecting intralesional mitomycin C (MMC) or steroid at stricture site, practicing clean intermittent selfcatheterization (CISC).

Material and methods:

This was a quasi-experimental study conducted in the Department of Urology, Sir Salimullah Medical College Mitford Hospital, carried out during April 2022 to September 2023. A total of 50 adult male patients with bulbar urethral stricture (up to 1.5 cm) were purposively selected for the study. Patients were grouped into Group-A (n=25, prior intralesional of 0.1 % MMC and OIU) and group-B (n=25, both OIU and CISC) with alternate assignment. Two of 25 patients in group A and three of 25 patients in group B lost to follow up. Hence total of forty five patients completed the study. Follow ups were done at 7th post-operative day, 3rd month, 6th month and 12th month. Data analysis was done by SPSS version 25.

Results:

Demographic characteristics were similar across the two groups in terms of age, residence, occupation (p≥0.05). No significant difference was noted in baseline length of stricture, maximum urine flow rate, and post voidal residual volume (p≥0.05). At postoperative 3rd, 6th and 12th month follow up, post-operative Qmax was statistically higher (p<0.05) among group A patients (25.64±7.86 ml/sec Vs 20.47±5.48 ml/sec at 3rd month follow up, 23.97±7.62 ml/sec Vs 19.52±4.38 ml/sec at 6th month follow up and 23.08±5.11 ml/sec Vs 19.45±5.83 ml/sec at 12th month follow up in group A Vs group B respectively). Besides, at postoperative 3rd, 6th and 12th month follow ups, post-operative PVR was higher among group B patients but there was no statistical significant difference (p≥0.05) (22.92±7.59 ml Vs 25.44±6.89 ml at 3rd month follow up, 27.60±17.11 ml Vs 29.17±8.23 ml at 6th month follow up and 30.47±16.35 ml Vs 36.27±11.79 ml at 12th month follow up in group A Vs group B respectively). Recurrence of urethral stricture is higher in group B but not statistically significant (p≥0.05) in group B patients comparing to group A patients (18.20% Vs 8.7% in group B Vs group A respectively). Besides, UTI was higher in group B patients comparing to group A patients and the difference is statistically significant at 3rd and 6th month follow up (36.4% Vs 8.7% and 40.9% Vs 13% in group B vs group A at 3rd and 6th month follow up respectively, p = 0.026 & 0.035 p<0.05).