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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
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). Patients who underwent DVIU with intralesional MMC for recurrent B...
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| Published in: | Urology (Ridgewood, N.J.) N.J.), 2021-01, Vol.147, p.294-298 |
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| cites | cdi_FETCH-LOGICAL-c365t-8e4beb0ca921290e0261958fecb083e05fe56f0c3cdc1ae17e442400b547d48e3 |
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| container_title | Urology (Ridgewood, N.J.) |
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| creator | Rozanski, Alexander T. Zhang, Lawrence T. Holst, Daniel D. Copacino, Steven A. Vanni, Alex J. Buckley, Jill C. |
| description | 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).
Patients who underwent DVIU with intralesional MMC for recurrent BNC/VUAS between 2007 and 2019 at 2 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 90% of nonradiated patients and >75% of radiated patients. |
| doi_str_mv | 10.1016/j.urology.2020.09.035 |
| format | article |
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Patients who underwent DVIU with intralesional MMC for recurrent BNC/VUAS between 2007 and 2019 at 2 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 <3 months follow-up were excluded. Success was defined as the ability to pass a 17-French cystoscope postoperatively without the need for catheterization or additional procedures.
Eighty-six patients were analyzed over a median follow-up of 21.1 months. Around 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). Nonradiated 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. Two patients underwent subsequent urinary diversion surgery. No long-term complications were seen.
DVIU with low-dose MMC remains a safe and effective BNC/VUAS treatment. A patent bladder neck was achieved in >90% of nonradiated patients and >75% of radiated patients.</description><identifier>ISSN: 0090-4295</identifier><identifier>EISSN: 1527-9995</identifier><identifier>DOI: 10.1016/j.urology.2020.09.035</identifier><identifier>PMID: 33035561</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Anastomosis, Surgical - adverse effects ; Combined Modality Therapy ; Cryosurgery ; Follow-Up Studies ; Humans ; Injections, Intralesional ; Male ; Mitomycin - administration & dosage ; Recurrence ; Retrospective Studies ; Urethra - surgery ; Urethral Stricture - drug therapy ; Urethral Stricture - radiotherapy ; Urinary Bladder Neck Obstruction - drug therapy ; Urinary Bladder Neck Obstruction - radiotherapy</subject><ispartof>Urology (Ridgewood, N.J.), 2021-01, Vol.147, p.294-298</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-8e4beb0ca921290e0261958fecb083e05fe56f0c3cdc1ae17e442400b547d48e3</citedby><cites>FETCH-LOGICAL-c365t-8e4beb0ca921290e0261958fecb083e05fe56f0c3cdc1ae17e442400b547d48e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33035561$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rozanski, Alexander T.</creatorcontrib><creatorcontrib>Zhang, Lawrence T.</creatorcontrib><creatorcontrib>Holst, Daniel D.</creatorcontrib><creatorcontrib>Copacino, Steven A.</creatorcontrib><creatorcontrib>Vanni, Alex J.</creatorcontrib><creatorcontrib>Buckley, Jill C.</creatorcontrib><title>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</title><title>Urology (Ridgewood, N.J.)</title><addtitle>Urology</addtitle><description>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).
Patients who underwent DVIU with intralesional MMC for recurrent BNC/VUAS between 2007 and 2019 at 2 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 <3 months follow-up were excluded. Success was defined as the ability to pass a 17-French cystoscope postoperatively without the need for catheterization or additional procedures.
Eighty-six patients were analyzed over a median follow-up of 21.1 months. Around 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). Nonradiated 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. Two patients underwent subsequent urinary diversion surgery. No long-term complications were seen.
DVIU with low-dose MMC remains a safe and effective BNC/VUAS treatment. A patent bladder neck was achieved in >90% of nonradiated patients and >75% of radiated patients.</description><subject>Aged</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Combined Modality Therapy</subject><subject>Cryosurgery</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Injections, Intralesional</subject><subject>Male</subject><subject>Mitomycin - administration & dosage</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Urethra - surgery</subject><subject>Urethral Stricture - drug therapy</subject><subject>Urethral Stricture - radiotherapy</subject><subject>Urinary Bladder Neck Obstruction - drug therapy</subject><subject>Urinary Bladder Neck Obstruction - radiotherapy</subject><issn>0090-4295</issn><issn>1527-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFkcGO0zAQhi0EYsvCI4B85JIwTuK05oJKVaDSLkjLLhwtx5lQl9QutoPIm_I4OJvClZMtz_fPyPMR8pxBzoDVrw754F3vvo15AQXkIHIo-QOyYLxYZkII_pAsAARkVSH4BXkSwgEA6rpePiYXZZlgXrMF-X27R7rtOtSRuo7eqNaoaJyl6d2r00jTNc6I0UqPE7SzEb1VPb3zGPfeRXcc6VcT91PFqx5DapDK12aqaGPphnbO0xvUg_doI_2SEO2G-3gC11aFhLpoNP0c0bqAgSrb0re9alv09CPq73Tjpu46plh4Tdf0euijyXY2RBOHOI_c_jqhN2g1PiWPOtUHfHY-L8ndu-3t5kN29en9brO-ynRZ85itsGqwAa1EwQoBCEXNBF-lfTSwKhF4h7zuQJe61UwhW2JVFRVAw6tlW62wvCQv574n734MGKI8mqCx75VFNwRZVFWSUfFaJJTPqPYuBI-dPHlzVH6UDOQkVR7kWaqcpEoQMnlKuRfnEUNzxPZf6q_FBLyZAUwf_WnQy6Dvl9Aan8TK1pn_jPgDYsm7zA</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Rozanski, Alexander T.</creator><creator>Zhang, Lawrence T.</creator><creator>Holst, Daniel D.</creator><creator>Copacino, Steven A.</creator><creator>Vanni, Alex J.</creator><creator>Buckley, Jill C.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202101</creationdate><title>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</title><author>Rozanski, Alexander T. ; Zhang, Lawrence T. ; Holst, Daniel D. ; Copacino, Steven A. ; Vanni, Alex J. ; Buckley, Jill C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-8e4beb0ca921290e0261958fecb083e05fe56f0c3cdc1ae17e442400b547d48e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Combined Modality Therapy</topic><topic>Cryosurgery</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Injections, Intralesional</topic><topic>Male</topic><topic>Mitomycin - administration & dosage</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Urethra - surgery</topic><topic>Urethral Stricture - drug therapy</topic><topic>Urethral Stricture - radiotherapy</topic><topic>Urinary Bladder Neck Obstruction - drug therapy</topic><topic>Urinary Bladder Neck Obstruction - radiotherapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rozanski, Alexander T.</creatorcontrib><creatorcontrib>Zhang, Lawrence T.</creatorcontrib><creatorcontrib>Holst, Daniel D.</creatorcontrib><creatorcontrib>Copacino, Steven A.</creatorcontrib><creatorcontrib>Vanni, Alex J.</creatorcontrib><creatorcontrib>Buckley, Jill C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urology (Ridgewood, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rozanski, Alexander T.</au><au>Zhang, Lawrence T.</au><au>Holst, Daniel D.</au><au>Copacino, Steven A.</au><au>Vanni, Alex J.</au><au>Buckley, Jill C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Urology (Ridgewood, N.J.)</jtitle><addtitle>Urology</addtitle><date>2021-01</date><risdate>2021</risdate><volume>147</volume><spage>294</spage><epage>298</epage><pages>294-298</pages><issn>0090-4295</issn><eissn>1527-9995</eissn><abstract>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).
Patients who underwent DVIU with intralesional MMC for recurrent BNC/VUAS between 2007 and 2019 at 2 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 <3 months follow-up were excluded. Success was defined as the ability to pass a 17-French cystoscope postoperatively without the need for catheterization or additional procedures.
Eighty-six patients were analyzed over a median follow-up of 21.1 months. Around 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). Nonradiated 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. Two patients underwent subsequent urinary diversion surgery. No long-term complications were seen.
DVIU with low-dose MMC remains a safe and effective BNC/VUAS treatment. A patent bladder neck was achieved in >90% of nonradiated patients and >75% of radiated patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33035561</pmid><doi>10.1016/j.urology.2020.09.035</doi><tpages>5</tpages></addata></record> |
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| ispartof | Urology (Ridgewood, N.J.), 2021-01, Vol.147, p.294-298 |
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| language | eng |
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| source | ScienceDirect Freedom Collection 2022-2024 |
| subjects | Aged Anastomosis, Surgical - adverse effects Combined Modality Therapy Cryosurgery Follow-Up Studies Humans Injections, Intralesional Male Mitomycin - administration & dosage Recurrence Retrospective Studies Urethra - surgery Urethral Stricture - drug therapy Urethral Stricture - radiotherapy Urinary Bladder Neck Obstruction - drug therapy Urinary Bladder Neck Obstruction - radiotherapy |
| title | 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 |
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