The Role of Mitomycin C Injection During Visual Internal Urethrotomy in Urethral Stricture Recurrence

Background: A popular minimally invasive therapy for short bulbar urethral stricture is direct visual internal urethrotomy (DVIU). Despite technological breakthroughs, postoperative recurrence rates remain high. Mitomycin C, an antifibrotic drug that suppresses fibroblast proliferation and collagen deposition, may minimise scarring and enhance surgical results. Objective: Assess the safety and effectiveness of intralesional Mitomycin C injection during DVIU in minimising urethral stricture recurrence. Methods: This prospective, randomised controlled trial comprised 27 symptomatic primary or recurring urethral stricture patients from December 2015 to September 2017. Clinicians used clinical history, physical examination, abdominal ultrasonography, uroflowmetry, and retrograde urethrography to diagnose. DVIU alone (n=13) or DVIU with intralesional Mitomycin C injection (n=14) was randomly assigned. Age, stricture length, aetiology, and Qmax were recorded as baseline demographics and clinical data. Postoperative urine flow improvement, complications, recurrence rate, and time were monitored. Results: Baseline characteristics were comparable between both groups. Significant improvement in postoperative Qmax was observed in both groups. Postoperative complications were minimal and showed no significant difference between treatment groups. The Mitomycin C group demonstrated a significantly lower recurrence rate than the control group (p=0.021), with recurrence occurring later during follow-up. Conclusion: Intralesional Mitomycin C injection is a safe and effective adjunct to DVIU for short bulbar urethral stricture. It significantly reduces postoperative recurrence and prolongs recurrence-free survival, supporting its use as an adjuvant therapy to improve long-term clinical outcomes.