Urethral Strictures Associated with the Management of Non Muscle Invasive Bladder Carcinoma


ABSTRACT:BACKGROUND:Carcinoma of Bladder is a common urological tumor. Urethral strictures with different grades are frequently seen in patients with non muscle invasive bladder cancer .OBJECTIVE:To elicit the incidence of urethral strictures, their severity and correlation with different factors in patients managed for non muscle invasive bladder tumor.PATIENTS AND METHODS:In a prospective study from January 2008 to January 2010 ,we followed 98 patients with superficial bladder tumor ,they were all male their age ranged from 38-76 years, all patients diagnosed endoscopically and histologically staged as superficial bladder tumor (excluding invasive bladder tumor),we follow those patients with a history regarding any change in urinary stream then urethrocystoscopically during a period of 1-2 years, we classify urethral strictures that was urethroscopically diagnosed as mild, moderate and sever.For each urethral stricture case we state the site and severity of the stricture, the number of preceding cystoscopies, duration of TURBT procedure and number of preceding chemotherapy sessions , the type of chemotherapy used and method of treatment required in each case.RESULTS:During the period of the study , a total of 23 urethral strictures (23.5%) were identified. They were all in the bulbar urethra, they were mild in 10 patients (43.5%), Moderate in 6 patients (26.1%) and sever in 7 patients (30.4%) and 14 patients with urethral stricture had also B.P.H(60.9%).Prior to the occurrence of stricture; urethrocystocopy was done once in 55.5% of cases , twice in 26.1% and 3 or more in 17.4%.Duration of TURBT procedure was≤20 mints in 30.4% and > 20 mints in 69.6%.Intravesical chemotherapy sessions were 0-3 in 17.4% of patients, 6 in 43.5% and more than 6 in 39.1%.The type of chemotherapeutic agent used was Doxorubicin in 56.5% of patients Mitomycin-c- in 26.1% and both of them (through multiple courses) in 13%.CONCLUSION:Urethral stricture associated with the management of non muscle invasive bladder tumors is a common and important clinical problem that need to be considered and avoided as far as possible ,Factors that may had a positive impact on the incidence of stricture were : B.P.H , duration of TURBT procedure, the number of intravesical chemotherapy sessions(6 and more) and doxorubicin instillation.