The Effect of Radiation Therapy on the Efficacy of Internal Urethrotomy with Intralesional Mitomycin C for Recurrent Vesicourethral Anastomotic Stenoses and Bladder Neck Contractures: A Multi-Institutional Experience.

Abstract Objective To assess the efficacy, effect of radiotherapy, and complications of direct visual internal urethrotomy (DVIU) and intralesional mitomycin C (MMC) for recurrent bladder neck contracture/vesicourethral anastomotic stenosis (BNC/VUAS). Methods Patients who underwent DVIU with intralesional MMC for recurrent BNC/VUAS between 2007-2019 at two institutions were included. Cold knife incisions were performed in a reproducible fashion followed by injection of 0.3-0.4 mg/mL MMC at each incision site. Those with evidence of complete urethral obliteration, stenosis of the entire posterior urethra, or Results 86 patients were analyzed over a median follow-up of 21.1 months. 91% had at least 1 prior DVIU, 56% had at least 1 prior dilation, and 44% presented with an indwelling catheter or performed intermittent catheterization. Success was achieved in 65% after 1 procedure, an additional 18% after 2 procedures, and another 7% after 3 or more procedures (90% overall success rate). Non-radiated patients showed a higher overall success rate compared to radiated patients (94% vs. 76%, p=0.04). Of the 9 cystoscopic failures, 5 were asymptomatic and pursued observation. Only 2 (5%) patients with a history of catheterization required this postoperatively. 2 patients underwent subsequent urinary diversion surgery. No long-term complications were seen. Conclusions DVIU with low-dose MMC remains a safe and effective BNC/VUAS treatment. A patent bladder neck was achieved in >90% of non-radiated patients and >75% of radiated patients.