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Abstract

Introduction:

The long-term cure rate for nonradiation-associated strictures after a direct visual internal urethrotomy (DVIU) is as low as 30%–40%. Injection of mitomycin C (MMC) after DVIU has been shown to have a cure rate of around 75%. We present our step-by-step process of DVIU and injection of MMC.

Methods:

We use a 22F optical urethrotome with a 12° lens and a semicircular knife for the DVIU after passing a 145 cm, 0.035″ Coons Bentson Wire into the bladder. For the MMC injection portion of the procedure, we switch to a 21F urethroscope sheath and obturator with a 30° lens and an aspiration and injection needle. Four milligrams of MMC is diluted with sterile injectable saline for a total of 10 mL. Twenty 0.5 mL injections are performed along the length of the stricture.

Results:

We reviewed the patients' characteristics, operative details, and perioperative courses in the 44 patients who underwent a DVIU and injection of MMC. Median follow-up was 23.8 months (range 4.8–62.8 months). Seventy-five percent (33/44) of patients required no further surgery after the first DVIU and injection of MMC. Seven of the remaining 11 patients underwent a second visual internal urethrotomy and injection of MMC. There were no immediate or long-term complications after DVIU with immediate injection of MMC.

Conclusion:

DVIU with immediate injection of MMC is a safe and effective procedure with high success rates for bulbar and bulbomembranous urethral strictures.

Authors' Contribution:

W.P.T. drafted the article and created the video. M.R.F. analyzed the data. L.A.L. reviewed and edited the article and video. All authors read and approved the final article and video.