To report the safety and efficacy of mitomycin-C (MMC) injection followed by urethral dilatation for the treatment of recurrent vesicourethral anastomotic stenosis (VUAS) post-radical prostatectomy, and to report the outcome for patients treated for concomitant postprostatectomy incontinence.
A total of 29 patients with postprostatectomy incontinence and diagnosed with recurrent VUAS were recruited between March 2009 and January 2014 in this longitudinal case series. Under sedation, MMC was injected at the 3, 6, and 9 o'clock position, followed by urethral dilatation to 26F. Cystoscopy was performed to evaluate for patency at set intervals. Patients had the possibility to receive a salvage MMC injection if recurrence was noted. Patients with resolved VUAS were offered an anti-incontinence surgery.
Median (interquartile range [IQR]) patient age was 67 years (63-72). Overall, 17 patients had ≥2 prior treatments for the VUAS (median = 2, IQR: 1-3 treatments); 23 patients (79%) had a patent bladder neck at the 12 months follow-up cystoscopy after a single MMC injection and dilatation. Overall, 3 patients opted for a salvage MMC injection for recurrence, and 2 of those were salvaged, improving the success rate to 86%. No adverse events were reported. Overall, 20 patients (69%) opted for an anti-incontinence surgery, and all were either cured or improved of their incontinence after a median (IQR) follow-up of 58 months (48-77).
MMC injection with urethral dilatation is a safe, effective, and minimally invasive treatment option for recurrent VUAS after radical prostatectomy. Favorable long-term results can be expected even after anti-incontinence procedures.
Urologic oncology. 2017 Aug 24 [Epub ahead of print]
Michael Wadih Sourial, Patrick O Richard, Mathieu Bettez, Mazen Jundi, Le Mai Tu
Departments of Surgery, Faculté de Médecine et Science de la Santé de l'Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada. Electronic address: ., Departments of Surgery, Faculté de Médecine et Science de la Santé de l'Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada., Department of Surgery, Hôpital Cité-de-la-Santé de Laval, Laval, Québec, Canada., Department of Surgery, CSSS Trois-Rivière, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivière, Québec, Canada., Departments of Surgery, Faculté de Médecine et Science de la Santé de l'Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.