Intralesional Mitomycin C with Optical Internal Urethrotomy (OIU) in the treatment of bulbar urethral stricture has better outcome compared to OIU with CISC.

Type of study: Quasi Experimental Study 
Period of study: Eighteen months (April 2022 to September 2023) 
Place of study: Department of Urology, Sir Salimullah Medical College Mitford Hospital, Dhaka. 
Study population: Adult male patients with bulbar urethral stricture  
Study sample: Adult male patients with bulbar urethral stricture (< 1.5 cm) admitted in the Department of Urology, Sir Salimullah Medical College Mitford Hospital during the study period. Sampling technique: Purposive sampling method with alternate assignment.

From total of 50 patients, 5 (10%) patients discontinued the study. Two (8%) of 25 patients in group A and three (12%) of 25 patients in group B lost to follow up. 

Distribution of the study patients by age (N=45) 29 Age group (year) Group A N = 23 n (%) 
Group B N = 22 n (%) 
p value 18-20  21-30 31-40 41-50 1 (4) 12 (52.2) 7 (30.4) 3 (12) 0 (0)  9 (41) 9 (41) 4 (18) 0.615* Group A: Patients underwent prior Intralesional Mitomycin C (MMC) with Optical Internal Urethrotomy (OIU) 
Group B: Patients underwent Optical Internal Urethrotomy (OIU) followed by Clean intermittent Self Catheterization (CISC) 
N = total number, n = number of positive p value was determined by chi-square test*  
In group A, majority of the study patients belonged to the age group 21-30 year (52.2%) followed by in decreasing order 31-40 year (30.4%), 41-50 year (12%) and 18-20 year (4%). 
The mean age of the patients (±SD) was 32.32 (±7.68) year.   
In group B, the majority of the study patients belonged to the age group 21-30 and 3140 year (41% in each group) and followed by the age group 41-50 year (18%). 
The mean age (±SD) was 33.84 (±6.51) year.  
No statistical difference was observed in age distribution of both groups (p≥0.05).

Instead of CISC, Intralesional Mitomycin C may be used with optical internal urethrotomy in the treatment of bulbar urethral stricture.  
A large, multicentre randomized study with long follow up period and correlation of recurrence with depth of spongiofibrosis is required for further comment.

In conclusion, this study has shown that the outcomes of Intralesional Mitomycin C with Optical Internal Urethrotomy are superior to Optical Internal Urethrotomy with Clean Intermittent Self Catheterization for the treatment of bulbar urethral stricture, mainly due to significant improvement of post-operative maximum urine flow rate (Qmax) and lower incidence of urinary tract infection. This study also observes lower bulbar urethral stricture recurrence rate in MMC with OIU. This finding adds valuable evidence to the growing body of literature supporting the use of Mitomycin C in managing bulbar urethral strictures and sets a precedent for future studies to explore pharmacological modulation of wound healing post-urethrotomy.

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