Effect of Mitomycin - C and Triamcinolone on Preventing Urethral Strictures

ABSTRACT Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p<0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p=0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p=0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture.

Effect of Mitomycin - C and Triamcinolone on Preventing Urethral Strictures.

Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p<0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p=0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p=0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture.

Transvaginal repair using acellular collagen biomesh for the treatment of anterior prolapse.

PURPOSE: To determine the results and satisfaction of the patients underwent transvaginal repair of cystocele in our clinic. MATERIALS AND METHODS: From January 2006 to October 2010, 15 patients with a mean age of 64 years (ranged 47-85 years) underwent transvaginal cystocele repair using acellular collagen biomesh. The patients were presented with vaginal mass in 10, dyspareunia and urge incontinence in 5 while 4 of them had both stress and urge incontinence. Grade 4 cystocele was determined in 2 patients, grade 3 in 9 and grade 2 in 4. Concomitant transobturator tape (TOT) was performed in 4 patients. Patient satisfactions were determined after the operation. RESULTS: The mean follow-up time was 23.5 (12-60) months. There was no postoperative complication in early follow- up period. Cystocele was recurrent in 1 patient. The success rate was 93.4%. Urinary incontinence was continued in 1 patient after TOT. Nearly all of the patients (14/15) were satisfied from the operation. CONCLUSION: Transvaginal cystocele repair with using acellular collagen biomesh appears to be a safe and effective method. Further prospective and randomized controlled studies including large series of patients are needed.