To Compare The Efficacy Of Intralesional Mitomycin C Versus Traimcinolon In In Reducing The Recurrence Of Urethral Stricture After Internal Optical Urethrotomy

Abstract

Objectives: To compare the efficacy of intralesional mitomycin C versus triamcinolone in reducing the recurrence of urethral stricture after internal optical urethrotomy.

Materials and Methods:  This randomized control trial was conducted at Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar from January 2016 to January 2017. We enrolled 134 patients fulfilling the inclusion criteria. Urine R/E, blood investigation followed by x-ray KUB, ultrasound of the pelvis and abdomen once done with it then will proceed to retrograde urethrogram supplemented by Uroflometry & Flexible urethroscopy. Patient were regularly followed up on 3month interval for 1 year once the Mitomycin or triamcinolone injected intralesionally with TLA needle using straight working channel Pediatric cystoscope at 12, 3 & 9 o’ clock positions. On each follow up uroflowmetry, & if needed Retrograde Urethrogram (R.U.G) was performed. On last follow up R.U.G was mandatory to rule out stricture.

Results: Total 134 patients were enrolled in the study divided in to two groups Group A  (Intralesinal Mitomycin) and Group B (Triamcinolone) after internal optical urethrotomy.   Mean and SD of age for Group A was recorded as 47.4+14.2 and Group B was recorded as 46.58+14.27.

Overall, only 29 (21.64%) patients demonstrated recurrence, whereas in the remaining 105 (78.35%) patients no recurrence of urethral stricture post procedure was documented on follow up. 

In Group A the recurrence was recorded as 9 (6.71%) whereas 58 (43.28%) patients had no recurrence. In Group B 20 (14.92%) patients had recurrence whereas 47 (35.07%) patients had no recurrence. P Value= 0.021.  Frequency and percentage for stricture site between the two groups were recorded as 32 (23.88%) in Bulbar, 27 (20.14%) in Penile and 8 (5.79%) both Bulbar and Penile in Group A and in Group B 35 (26.11%) were recorded in Penile, 21 (15.67%) in Bulbar and 11 (8.20%) in both sites.

Conclusion: Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU in comparison with triamcinolone.