Abstract

David S Koslov, Robert Kovell, Kyle D Wood, Ilya Gorbachinsky, Ryan Terlecki

Latrogenic bladder neck contractures (BNC) represent a challenging problem for urologists and patients alike and may require several treatments to improve associated LUTS. Mitomycin C (MMC) injection as an adjunctive therapy to transurethral bladder neck incision (TUIBN) has shown promise in achieving durable bladder neck patency. We report outcomes from patients with BNC treated by TUIBN and subsequent injection of an adjunctive agent, either MMC and tacrolimus, an immunomodulator not previously tested but chosen for antifibrotic properties. This is a retrospective review of a single surgeon experience using MMC or tacrolimus injections after TUIBN for BNC. Thirteen patients with iatrogenic BNC were treated with TUIBN. Two were treated with laser incision alone. Two received post-incision injection with tacrolimus , and nine received post-incision injection with MMC after incision. Both patients treated with tacrolimus failed treatment and had obliterated bladder necks, while all MMC patients had patent bladder necks at follow up cystoscopy. MMC, but not tacrolimus, demonstrated safety and efficacy as an adjunctive therapy after TUIBN for refractory BN. Use of adjunctive injection of antifibrotic agents with TUIBN may be an effective method of maintaining bladder neck patency compared to simple incision.