Vol. 7, Issue 1, Part A (2025)

Urethral stricture is one of the oldest known urological diseases and remains a common problem with high morbidity. The most common kind of management for urethral stricture is optical internal urethrotomy (OIU) which is a minimally invasive procedure with lower morbidity. But there is a common postoperative complication after OIU, recurrence of stricture. To prevent this, several methods have been added with this therapeutic option like, injecting intralesional mitomycin C (MMC) or steroid at stricture site, practicing clean intermittent self- catheterization (CISC). To compare the outcome between intralesional MMC with OIU and OIU with CISC in the treatment of bulbar urethral stricture. This was a quasi-experimental study conducted in the Department of Urology, Sir Salimullah Medical College Mitford Hospital, carried out during April 2022 to September 2023. A total of 50 adult male patients with bulbar urethral stricture (up to 1.5 cm) were purposively selected for the study. Patients were grouped into Group-A (n=25, prior intralesional of 0.1% MMC and OIU) and group-B (n=25, both OIU and CISC) with alternate assignment. Two of 25 patients in group A and three of 25 patients in group B lost to follow up. Hence total of forty five patients completed the study. Follow ups were done at 7th post-operative day, 3rd month, 6th month and 12th month. Data analysis was done by SPSS version 25. Demographic characteristics were similar across the two groups in terms of age, residence, occupation (p≥0.05). No significant difference was noted in baseline length of stricture, maximum urine flow rate, and post voidal residual volume (p≥0.05). At postoperative 3rd, 6th and 12th month follow up, post-operative Qmax was statistically higher (p<0.05) among group A patients (25.64±7.86 ml/sec Vs 20.47±5.48 ml/sec at 3rd month follow up, 23.97±7.62 ml/sec Vs 19.52±4.38 ml/sec at 6th month follow up and 23.08±5.11 ml/sec Vs 19.45±5.83 ml/sec at 12th month follow up in group A Vs group B respectively). Besides, at postoperative 3rd, 6th and 12th month follow ups, post-operative PVR was higher among group B patients but there was no statistical significant difference (p≥0.05) (22.92±7.59 ml Vs 25.44±6.89 ml at 3rd month follow up, 27.60±17.11 ml Vs 29.17±8.23 ml at 6th month follow up and 30.47±16.35 ml Vs 36.27±11.79 ml at 12th month follow up in group A Vs group B respectively). Recurrence of urethral stricture is higher in group B but not statistically significant (p≥0.05) in group B patients comparing to group A patients (18.20% Vs 8.7% in group B Vs group A respectively). Besides, UTI was higher in group B patients comparing to group A patients and the difference is statistically significant at 3rd and 6th month follow up (36.4% Vs 8.7% and 40.9% Vs 13% in group B vs group A at 3rd and 6th month follow up respectively, p = 0.026 & 0.035 p<0.05). Intralesional Mitomycin C with OIU has better outcome. Hence, intralesional Mitomycin C with OIU is a good alternative for OIU with CISC in the treatment of bulbar urethral stricture.