Intralesional Mitomycin Research Articles

Topical versus interlesional mitomycin C in auricular keloids

BackgroundThe Keloid is an elevated fibrous scar that may extend beyond the borders of the original wound. ObjectTo compare between topical and intralesional mitomycin C in the treatment of auricular keloids. Patients and methodsProspective randomized study in which 40 patients with auricular keloids were included. The patients were divided into 2 groups, Group I included 32 patients who underwent topical mitomycin C application after the surgical removal of the auricular keloids, while Group II included 8 cases who underwent intra-lesional injection of mitomycin C after surgical removal of the auricular keloids. ResultsThe two groups showed no significant difference regarding patient or lesion criteria (p>.05). VSS decreased significantly from 10.63 and 11.0 down to 1.38 and 3.0 after treatment in the topical and intra-lesional groups respectively (p<.001). However, greater improvement and satisfaction was detected in the topical group. ConclusionBoth topical and intra-lesional mitomycin C injection are effective methods in managing auricular keloids. However, better VSS scores and patient satisfaction are reported with topical administration.

Topical versus interlesional mitomycin C in auricular keloids

BackgroundThe Keloid is an elevated fibrous scar that may extend beyond the borders of the original wound. ObjectTo compare between topical and intralesional mitomycin C in the treatment of auricular keloids. Patients and methodsProspective randomized study in which 40 patients with auricular keloids were included. The patients were divided into 2 groups, Group I included 32 patients who underwent topical mitomycin C application after the surgical removal of the auricular keloids, while Group II included 8 cases who underwent intra-lesional injection of mitomycin C after surgical removal of the auricular keloids. ResultsThe two groups showed no significant difference regarding patient or lesion criteria (p>.05). VSS decreased significantly from 10.63 and 11.0 down to 1.38 and 3.0 after treatment in the topical and intra-lesional groups respectively (p<.001). However, greater improvement and satisfaction was detected in the topical group. ConclusionBoth topical and intra-lesional mitomycin C injection are effective methods in managing auricular keloids. However, better VSS scores and patient satisfaction are reported with topical administration.

Incorporating intra-lesional injection of mitomycin C in the management algorithm for bladder neck contractures and vesicourethral anastomotic strictures

Objective: This study aims to describe the experience of a single-surgeon series with the use of intra-lesional mitomycin C (MMC) in the treatment of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS). Patients and methods: From July 2014 to January 2019, patients who underwent bladder neck incision (BNI) and intra-lesional MMC injection performed by a single surgeon were included in this retrospective study. Clinico-pathological data were extracted from medical records. The primary outcome was recurrence rate following BNI and MMC injection. Results: Ten patients were included in the study. The median age was 68 years. The cause of BNC or VUAS was secondary to radical prostatectomy in eight patients and to endoscopic prostatectomy in two patients. The median follow-up was 16.4 months. The success rate was 70% after first treatment with BNI and MMC injection, and 80% after repeated treatment. There were no serious adverse events or complications related to the MMC injection. Conclusion: BNI and intra-lesional MMC injection is a minimally invasive treatment for refractory bladder neck contractures with a good success rate and minimal risk of side effects when a low dose of MMC is used. Further prospective multicentre study is warranted. Level of evidence: Level 4.

The Effect of Radiation Therapy on the Efficacy of Internal Urethrotomy With Intralesional Mitomycin C for Recurrent Vesicourethral Anastomotic Stenoses and Bladder Neck Contractures: A Multi-Institutional Experience

To assess the efficacy, effect of radiotherapy, and complications of direct visual internal urethrotomy (DVIU) and intralesional mitomycin C (MMC) for recurrent bladder neck contracture/vesicourethral anastomotic stenosis (BNC/VUAS). Patients who underwent DVIU with intralesional MMC for recurrent BNC/VUAS between 2007 and 2019 at 2 institutions were included. Cold knife incisions were performed in a reproducible fashion followed by injection of 0.3-0.4 mg/mL MMC at each incision site. Those with evidence of complete urethral obliteration, stenosis of the entire posterior urethra, or <3 months follow-up were excluded. Success was defined as the ability to pass a 17-French cystoscope postoperatively without the need for catheterization or additional procedures. Eighty-six patients were analyzed over a median follow-up of 21.1 months. Around 91% had at least 1 prior DVIU, 56% had at least 1 prior dilation, and 44% presented with an indwelling catheter or performed intermittent catheterization. Success was achieved in 65% after 1 procedure, an additional 18% after 2 procedures, and another 7% after 3 or more procedures (90% overall success rate). Nonradiated patients showed a higher overall success rate compared to radiated patients (94% vs 76%, P=0.04). Of the 9 cystoscopic failures, 5 were asymptomatic and pursued observation. Only 2 (5%) patients with a history of catheterization required this postoperatively. Two patients underwent subsequent urinary diversion surgery. No long-term complications were seen. DVIU with low-dose MMC remains a safe and effective BNC/VUAS treatment. A patent bladder neck was achieved in >90% of nonradiated patients and >75% of radiated patients.

An international survey on anastomotic stricture management after esophageal atresia repair: considerations and advisory statements

BackgroundEndoscopic dilatation is the first-line treatment of stricture formation after esophageal atresia (EA) repair. However, there is no consensus on how to perform these dilatation procedures which may lead to a large variation between centers, countries and doctor’s experience. This is the first cross-sectional study to provide an overview on differences in endoscopic dilatation treatment of pediatric anastomotic strictures worldwide.MethodsAn online questionnaire was sent to members of five pediatric medical networks, experienced in treating anastomotic strictures in children with EA. The main outcome was the difference in endoscopic dilatation procedures in various centers worldwide, including technical details, dilatation approach (routine or only in symptomatic patients), and adjuvant treatment options. Descriptive statistics were performed with SPSS.ResultsResponses from 115 centers from 32 countries worldwide were analyzed. The preferred approach was balloon dilatation (68%) with a guidewire (66%), performed by a pediatric gastroenterologist (n = 103) or pediatric surgeon (n = 48) in symptomatic patients (68%). In most centers, hydrostatic pressure was used for balloon dilatation. The insufflation duration was standardized in 59 centers with a median duration of 60 (range 5–300) seconds. The preferred first-line adjunctive treatments in case of recurrent strictures were intralesional steroids and topical mitomycin C, in respectively 47% and 31% of the centers.ConclusionsWe found a large variation in stricture management in children with EA, which confirms the current lack of consensus. International networks for rare diseases are required for harmonizing and comparing the procedures, for which we give several suggestions.

Intralesional Mitomycin C Injection in Management of Caustic Esophageal Stricture in Children

Abstract Background Corrosive ingestion is a devastating event that induces significant burdens on modern health systems worldwide. The management of resulting esophageal strictures is challenging where endoscopic dilatation is the first line of management with varying rate of success. Aim of the Work We aimed at this work to study the feasibility and safety of intralesional Mitomycin C injection in patients with caustic localized esophageal stricture. Patients and Methods This study has been conducted at Pediatric Surgery Department, Pediatric Hospital, Ain Shams University Hospitals on eight pediatric patients with caustic esophageal stricture with variable degrees of dysphagia. We evaluated the clinical improvement of the dysphagia, as well as the intra and postoperative complications of Mitomycin C injection. Results Eight patients with short caustic esophageal stricture were managed with intralesional Mitomycin C injection adjuvant to endoscopic dilatation. Seven patients were completely cured from dysphagia with at least 6 months dysphagia free period. No intraoperative complications were documented while there were two cases who reported GIT side effect postoperative in the form of colics and non-bilious vomiting that resolved by medical treatment. Conclusion Intralesional Mitomycin C injection could be a good adjuvant therapy with endoscopic dilatation for caustic esophageal stricture. However, long-term observations are mandatory on a large scale of patients.

Efficacy of Mitomycin c in Reducing the Recurrence of Urethral Stricture after Visual Internal Urethrotomy (VIU)

Urethral stricture remains one of the oldest known urologic diseases and also still a common problem with high morbidity. Recurrence rate of VIU is high in different studies ranging from 20% to 60%, the aim of this study was to assess the efficacy of MMC in reducing the recurrence of urethral stricture after VIU. Our consider incorporated 30 patients torment from < 2 cm urethral stricture, starting with might 2018 should november 2019. These patients were randomized under two aggregations; gathering An (study group) incorporated 15 patients who were subjected with intralesional MMC then afterward VIU, What's more one assembly b (control group) incorporated 15 patients who were subjected to VIU best. Utilizing An Cold-knife those urethrotomy might have been performed under immediate dream What's more incisions were aggravated during 12-, 5-, What's more 7 O’clock positions taken after Toward intralesional infusion from claiming MMC. Every one patients were took after dependent upon to 6 months and the stricture repeat rate might have been compared the middle of those two aggregation. Of the aggregate 30 patients, 4 patients clinched alongside gathering a and 3 tolerant On one assembly b were lost should catch up in the initial 2 months Furthermore Subsequently were dropped from the ponder. Those test might have been consequently decreased will 23 patients who were separated under two aggregations. Bunch An (study group) comprised 11 patients who were subjected should intralesional mitomycin c's after VIU. Aggregation b (control group) comprised 12 patients who underwent VIU main. There might have been statistically critical Contrast the middle of 2 bunches in regards will stricture repeat ; 2 patients On one assembly a (18. 2%) Furthermore 7 patients On bunch b (58. 3%) required repeat (p=0. 02). Various intralesional MMC injections Emulating VIU need An possibility with markedly decrease those repeat about urethral stricture.

Durable Results of Mitomycin C Injection with Internal Urethrotomy for Refractory Bladder Neck Contractures: Multi-institutional Experience

IntroductionWe evaluated our intermediate term experience with radial urethrotomy and intralesional mitomycin C injection in patients with recurrent bladder neck contractures. Recurrent bladder neck contractures in which previous endoscopic treatment failed pose a difficult management dilemma. MethodsProspectively collected data were reviewed in a retrospective manner of patients presenting with recurrent bladder neck contractures from January 2007 to June 2014. All patients had at least 1 prior failed incision of a bladder neck contracture and many had additional dilations or catheter dependence. Radial cold knife incisions of the bladder neck were performed followed by injection of 0.3 to 0.4 mg/ml mitomycin C at each incision site. All surgeons performed the incision technique and injection in a reproducible fashion. ResultsA total of 40 patients underwent urethrotomy with mitomycin C injection. At a median followup of 20.5 months 30 patients (75.0%) had a stable bladder neck after 1 procedure. An additional 5 patients required 2 procedures to obtain a stable patent bladder neck (87.5%). Of the 40 patients 14 (35.0%) presented in retention on catheter drainage and all had a stable, patent bladder neck. No recurrence was detected in the original 18 patients in the pilot study with patent bladder necks. Rigorous followup revealed no long-term complications. ConclusionsUrethrotomy with mitomycin C injection for the management of recurrent bladder neck contractures is safe and efficacious. The addition of an antifibrotic agent in conjunction with internal urethrotomy offers a definitive solution to a problem that would otherwise be managed with repeat urethral incision/dilation, catheter dependence or open bladder neck reconstruction.

Visual Internal Urethrotomy With Intralesional Mitomycin C and Short-term Clean Intermittent Catheterization for the Management of Recurrent Urethral Strictures and Bladder Neck Contractures

To evaluate our longitudinal experience using visual internal urethrotomy (VIU) with intralesional mitomycin C (MMC) and short-term clean intermittent catheterization (CIC) for urethral strictures and bladder neck contractures (BNC) after failure of endoscopic management. This case series involved review of our prospectively developed database of all men who underwent VIU with MMC and CIC in a standardized fashion for urethral stricture or BNC between 2010 and 2013 at our tertiary care medical center. Etiology was identified as radiation-induced stricture (RIS) or non-RIS and analyzed by stricture location. Cold knife incisions were made in a tri or quadrant fashion followed by intralesional injection of MMC and 1 month of once daily CIC. All 37 patients previously underwent at least 1 intervention for urethral stricture or BNC before VIU with MMC and CIC. Mean stricture length was 2.0 cm (range, 1-6 cm; standard deviation, 1.0 cm). Over the median follow-up period of 23 months (range, 12-39 months), 75.7% of patients required no additional surgical intervention (RIS, 54.5%; non-RIS, 84.6%; P = .051). In those that did recur, median time to stricture recurrence was 8 months (range, 2-28 months). One patient with recurrence required urethroplasty. VIU with MMC followed by short-term CIC provides a minimally invasive and widely available tool to manage complex recurrent urethral strictures (<3 cm) and BNC without significant morbidity. This approach may be most attractive for patients who are poor candidates for open surgery.

Treatment of keloids and hypertrophic scars using topical and intralesional mitomycin C

Keloids develop due to the overgrowth of fibrous tissue. Currently, there is no gold standard treatment for keloids and hypertrophic scars (HTS). Their propensity for local invasion and recurrence has prompted many investigations on antineoplastic agents. To investigate the efficacy of topical and intralesional mitomycin C for the treatment of keloids and HTS. Nine patients with clinically diagnosed keloids and HTS were treated using topical mitomycin C (1 mg/mL) for 3 min after shaving excision. The Vancouver Scars Scale, patient satisfaction, and adverse effects were checked after 6 months. The keloids and HTS were photographed at each monthly visit. Intralesional mitomycin C (1 mg/mL) was administered to study the effect on the regression of keloids in 2 patients. Application of mitomycin C to the base of shave-removed keloids and HTS showed good results. Six out of 9 patients were very satisfied with the outcome of treatment; none were disappointed. The results of intralesional mitomycin C treatment were disappointing. Both cases worsened, with increased ulceration after treatment. Topical application of mitomycin C following shaving excision was safe and effective for the treatment of keloids and HTS. However, intralesional mitomycin C therapy aggravated both lesions.

Radial Urethrotomy and Intralesional Mitomycin C for the Management of Recurrent Bladder Neck Contractures

We evaluated urethrotomy combined with intralesional injection of the antiproliferative agent mitomycin C for the treatment of severe, recurrent bladder neck contractures after traditional endoscopic management failed. We report our experience with radial urethrotomy and intralesional mitomycin C in patients with recurrent bladder neck contractures. A retrospective review was performed of patients evaluated for severe, recurrent bladder neck contractures between January 2007 and April 2010. All patients had at least 1 prior failed incision of a bladder neck contracture. Tri or quadrant cold knife incisions of the bladder neck were performed followed by injection of 0.3 to 0.4 mg/ml mitomycin C at each incision site. A total of 18 patients were treated with bladder neck incision and mitomycin C injection. Preoperatively 4 (22%) patients presented with indwelling Foley catheters while 7 (39%) required a dilation schedule. At a median followup of 12 months (range 4 to 26) 13 patients (72%) had a patent bladder neck after 1 procedure, as did 3 (17%) after 2 procedures and 1 after 4 procedures. All of the patients presenting with a prior indwelling urethral catheter or requiring a dilation schedule had a stable, patent bladder neck. Management of recurrent bladder neck contractures with radial urethrotomy combined with intralesional mitomycin C resulted in bladder neck patency in 72% of the patients after 1 procedure and in 89% after 2 procedures. Although early results are promising, longer followup and randomized, prospective studies are required to validate these findings.

Intralesional mitomycin C: successful treatment for benign recalcitrant esophageal stricture

View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image A 36-year-old woman was evaluated for dysphagia 14 months after radical neck dissection with total laryngectomy and radiotherapy (I-131) for recurrent thyroid carcinoma, initially treated 8 years previously with thyroidectomy and postoperative I-131 ablation. Upper endoscopy revealed a complete obstruction in the proximal esophagus (A). The following day, the patient underwent endoscopy simultaneously from the mouth and via a gastrostomy. An endosurgical incision was made to reestablish continuity by a rendezvous procedure (B). View Large Image Figure Viewer Download Hi-res image