MP15-06 BIPOLAR INCISION OF BLADDER NECK CONTRACTURE WITH INTRALESIONAL INJECTION OF MITOMYCIN C: A SINGLE INSTITUTION EXPERIENCE

Abstract

INTRODUCTION AND OBJECTIVES: Transurethral incision of bladder neck contracture (TUIBNC) has high failure rates, prompting concomitant injection of a scar modulator. We present our single institution series of bipolar TUIBNC with immediate mitomycin C (MMC) injection to determine if the combination therapy could improve patency rates. METHODS: Records for all patients who underwent TUIBNC with intralesional MMC at a single institution from 2013e2014 were retrospectively reviewed. Instruments used were the biopolar Gyrus ACMI PK button electrode or PK Plasma-CISE . A total of 2mg of 40% mitomycin C solution was injected in four quadrants of the treated BNC. Postoperatively, patients were monitored for stricture recurrence using a combination of serial postvoid residuals, uroflowometry and flexible cystoscopy. Failure was defined as the need for subsequent intervention. RESULTS: Fifteen patients underwent bipolar TUIBNC with MMC. All were Caucasian males with a median age of 66 years (IQR 6). Etiologies included radical prostatectomy (8), transurethral prostate resection (3), radical cystoprostatectomy (2), and prostate brachytherapy (2). Fourteen (93%) patients had failed at least one prior intervention. Overall, 7 (47%) patients recurred following an initial TUIBNC with MMC at a median follow up of 9.9 months (IQR 9.2). Six of the 7 chose to undergo repeat TUIBNC with MMC, 2 (33%) of whom recurred during median follow up of 7 months (IQR 11). Likelihood of BNC recurrence was not significantly associated with history of prior pelvic radiation (33% vs 56%, p 1⁄4 0.4). Two patients experienced a postoperative complication but no serious adverse events occurred. CONCLUSIONS: Bipolar TUIBNC with MMC injection had lower than expected efficacy with a 10-month failure rate near 50%.