JCU - January 2022 - 51

Yao et al.
51
Figure 1. Management algorithm for bladder neck contracture and vesicourethral anastomotic stenosis.
patients in all of the studies, it is entirely possible that all studies
are underpowered to detect such a difference.
Adverse outcomes
The three most significant adverse events were reported by
Redshaw et al., which included osteitis pubis requiring cystectomy
and continent cutaneous diversion in two patients
and recto-urethral fistula in one patient.14 Redshaw et al. postulated
that these adverse events were likely secondary to
high doses of MMC, as three out of four patients with adverse
events had a dose of ⩾4 mg.14 This is likely the case, as our
study and others which used lower doses of intra-lesional
MMC all reported no serious adverse events.15,17,21,22
Alternatively, inadvertent extravesical administration may
have played a role as well.14 Three out of four patients with
adverse events in their study had prior pelvic radiotherapy.14
Although radiotherapy history alone may not have led to
these adverse events, it may have played a role in the development
of bladder neck and trigone necrosis secondary to
MMC injection.14 There was no reported systemic absorption
of MMC in any of the studies.
Proposed management algorithm
In light of the current literature, the authors have outlined
their management algorithm for patients who present
with BNC or VUAS (Figure 1). For patients with no

JCU - January 2022

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