Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis

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This study aims to investigate the efficacy of Mitomycin-C in treating anterior urethral stricture after internal urethrotomy. Methods Studies evaluating efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using Pubmed, Scopus, Sciencedirect, MEDLINE, and Cochrane Reviews as directory databases. The search was done in March 15th 2020. Terms being used in the searching process were “mitomycin-c” or “mitomycin”, “urethral stricture”, “urethral stenosis”, “internal urethrotomy”, “optical urethrotomy” and its synonyms. Every study with the design of retrospective or prospective clinical study being done in human subject was included. Study appraisal conducted in accordance to Oxford University Center for Evidence-Based Medicine. The conclusion of each study was summarized and the calculation of random effects from every study was conducted in meta-analysis. Random effects model is chosen because small number of studies and quite different. Results Three studies involving 311patients were included in this review, all of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). Risk ratio of all studies was 0.41 with 95% confidence interval (0.25-0.68). Conclusion Mitomycin-C has the potential of efficacy in treating anterior urethral stricture post internal urethrotomy. Relatively few numbers of studies may impact in the strength of this review and further studies need to be done." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/8-1390/v3", "name": "Efficacy of mitomycin-C on anterior urethral stricture after internal..." } } ] } Home Browse Efficacy of mitomycin-C on anterior urethral stricture after internal... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Irdam GA, Wahyudi I and Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.12688/f1000research.19704.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Systematic Review Revised Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] Gampo Alam Irdam 1 , Irfan Wahyudi 1 , Andy Andy https://orcid.org/0000-0001-7005-8871 1 Gampo Alam Irdam 1 , Irfan Wahyudi 1 , Andy Andy https://orcid.org/0000-0001-7005-8871 1 PUBLISHED 10 Aug 2020 Author details Author details 1 Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia Gampo Alam Irdam Roles: Conceptualization, Methodology, Writing – Review & Editing Irfan Wahyudi Roles: Conceptualization, Data Curation, Methodology, Supervision, Writing – Review & Editing Andy Andy Roles: Conceptualization, Formal Analysis, Investigation, Validation, Writing – Original Draft Preparation OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background and Aim Mitomycin-C is a potent agent that plays an important role in tissue healing and scar formation. This study aims to investigate the efficacy of Mitomycin-C in treating anterior urethral stricture after internal urethrotomy. Methods Studies evaluating efficacy of mitomycin-c for anterior urethral stricture post urethrotomy were searched using Pubmed, Scopus, Sciencedirect, MEDLINE, and Cochrane Reviews as directory databases. The search was done in March 15th 2020. Terms being used in the searching process were “mitomycin-c” or “mitomycin”, “urethral stricture”, “urethral stenosis”, “internal urethrotomy”, “optical urethrotomy” and its synonyms. Every study with the design of retrospective or prospective clinical study being done in human subject was included. Study appraisal conducted in accordance to Oxford University Center for Evidence-Based Medicine. The conclusion of each study was summarized and the calculation of random effects from every study was conducted in meta-analysis. Random effects model is chosen because small number of studies and quite different. Results Three studies involving 311patients were included in this review, all of them reported less recurrence of in patients treated with mitomycin-c post urethrotomy (p<0.001). Risk ratio of all studies was 0.41 with 95% confidence interval (0.25-0.68). Conclusion Mitomycin-C has the potential of efficacy in treating anterior urethral stricture post internal urethrotomy. Relatively few numbers of studies may impact in the strength of this review and further studies need to be done. READ ALL READ LESS Keywords mitomycin-c, urethral stricture, internal urethrotomy Corresponding Author(s) Andy Andy ( [email protected] ) Close Corresponding author: Andy Andy Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2020 Irdam GA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Irdam GA, Wahyudi I and Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.12688/f1000research.19704.3 ) First published: 08 Aug 2019, 8 :1390 ( https://doi.org/10.12688/f1000research.19704.1 ) Latest published: 10 Aug 2020, 8 :1390 ( https://doi.org/10.12688/f1000research.19704.3 ) Revised Amendments from Version 2 Several changes have been made. In the methods section: inclusion and exclusion criteria has been restructured, study selection, data extraction, and risk of bias assessment have also been added. In results section: study flow diagram has been changed according to PRISMA guide, risk of bias, and result of side effects have been added. In Discussion: the first four paragraph has been deleted, risk of bias has been discussed, heterogeneity has been discussed, definition recurrence has been mentioned. Several changes have been made. In the methods section: inclusion and exclusion criteria has been restructured, study selection, data extraction, and risk of bias assessment have also been added. In results section: study flow diagram has been changed according to PRISMA guide, risk of bias, and result of side effects have been added. In Discussion: the first four paragraph has been deleted, risk of bias has been discussed, heterogeneity has been discussed, definition recurrence has been mentioned. See the authors' detailed response to the review by Laetitia M. O. de Kort See the authors' detailed response to the review by Farhad Shokraneh READ REVIEWER RESPONSES Background Urethral stricture often impairs quality of life and may result in a large economic burden 1 . There are several procedures available for treating this condition, ranging from minimally invasive procedures like internal optical urethrotomy (IOU) to invasive procedure such as urethroplasty, with or without grafting, and tissue engineering 2 . However, despite the methods available, urethral stricture often recurs. Several manipulations have been tried to prevent urethral stricture, such as indwelling catheter insertion, urethral calibration procedure, and home self-catheterization. Unfortunately, repeated instrumentation can cause scar formation. Moreover, it can also complicate subsequent reconstruction, which can lead to several complications 3 , 4 . On the other hand, there have been several studies evaluating the effects of antifibrotic drugs such as glucocorticoid and mitomycin-C on urethral strictures. Mitomycin-C is an agent that has the potential to inhibit mitosis, fibroblast proliferation, formation of blood vessels, and synthesis of protein and collagen. This agent plays role in tissue healing process and scar formation by reducing the release of matrix proteins by inhibiting proliferative fibroblasts 5 . To our knowledge, there have not been any systematic reviews or meta-analyses regarding the efficacy of mitomycin-C in treating anterior urethral stricture post internal urethrotomy. Thus, the present study aims to investigate the efficacy of mitomycin-C in treating anterior urethral stricture post internal urethrotomy. We hope that by conducting this review and analysis, a definite conclusion regarding the efficacy of such treatment could be achieved. Methods This systematic review was conducted based on guidelines from the Oxford University Center for Evidence-Based Medicine 6 . Our present study aims to determine whether mitomycin-C provide better efficacy compared to controls (without mitomycin-C) in adult patients with anterior urethral stricture after internal urethrotomy. Inclusion and exclusion criteria Inclusion criteria were (1) Study type: RCT (Randomized Control Trial) until March 15th 2020; (2) Intervention and comparator: internal urethrotomy with addition Mitomycin-C vs internal urethrotomy without Mitomycin-C; (3) Patients: humans with anterior urethral stricture; (4) Primary outcome: efficacy of Mitomycin-C administration, determined by risk ratio; and (5) Secondary outcome: side effects from Mitomycin-C administration. Exclusion criteria were (1) Animal study; (2) case reports); (3) case series; (4) book chapters; and (5) editorials. Search strategy To find suitable studies to be included in this review, we used PubMed, Scopus, ScienceDirect, MEDLINE, and Cochrane Reviews as directory databases. We used combination of keywords “((((((mitomycin c[MeSH Terms]) OR mitomycin[MeSH Terms]) OR mitomycin c)) AND ((((((((((((((((urethral stricture[MeSH Terms]) OR urethral strictures[MeSH Terms]) OR stricture, urethral[MeSH Terms]) OR strictures, urethral[MeSH Terms]) OR urethral stenosis[MeSH Terms]) OR urethral stenoses[MeSH Terms]) OR stenosis, urethral[MeSH Terms]) OR stenoses, urethral[MeSH Terms]) OR urethral stricture) OR urethral strictures) OR stricture, urethral) OR strictures, urethral) OR urethral stenosis) OR urethral stenoses) OR stenosis, urethral) OR stenoses, urethral)) AND “urethra/surgery”[MeSH Terms]) AND Humans[Mesh]”. We also used term “human” as limiting term to exclude every study that was not conducted on human subjects. Study selection and data extraction A single reviewer screened the articles based on the titles, abstracts, and full text. Then, the data on author, publication year, details of studies subjects, details of studies intervention, and results are extracted. Risk of bias sssessment Another single reviewer assessed the risk of bias using the Cochrane Risk of Bias Tool, which include random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, and selective reporting. Every domain was judged with 3 levels (low risk, unclear risk, and high risk). Analysis and concluding the review We evaluated the study using appraisal worksheet for randomized clinical trial from Oxford University Center for Evidence-Based Medicine to stratify the risk of bias 6 . Using Revman 5.3 software, recurrence number from all selected studies were analyzed. Data were analyzed using forest plots with calculation of random effects. It was also done using Revman 5.3 to show relative risk/risk ratio for recurrence rate variable dan p-value. We summarized the conclusion of each study at the table along with its appraisal. We decided to use random effects model since the small amount of study and the difference between them. Results Literature search Searching process (searching strategy showed in Figure 1 ) by using five databases found 49 study articles. There were 13 articles eliminated after screening for duplication. The remained 36 articles were reduced to seven articles after title and abstract screening, leaving seven full text articles to be reviewed. Based on study design, we eliminated three articles, leaving four articles to be summarized in systematic review and meta-analysis. Figure 1. Study flow diagram. Study characteristics and quality assessment Four selected studies were conducted in 2007, 2015, 2016, and 2019 2 , 4 , 7 , 8 . All studies evaluated the effectivity of mitomycin-C given after internal urethrotomy for anterior urethral stricture. From these selected articles, three evaluated the usage of submucosal injection of mitomycin-C for anterior urethral stricture after urethrotomy. How mitomycin-C was injected differed in every study. Mazdak et al. 4 study used 0,1 mg of Mitomycin-C in 2 ml of distilled water injected in four quadrants, Ali et al. 2 study used 0,1% Mitomycin-C injected in three quadrants, and Islam et al. 7 study used 0,1 mg in 2 ml of distilled water in two quadrants. Moradi et al. 8 study evaluated intraluminal injection of Mitomycin-C in hydrogel base, consisting of 0.8 mg Mitomycin-C with 1cc water and propylene glycol to PF-127 poloxamer. The hydrogel base was injected through a small feeding tube to reach the site of stricture. All studies applied mitomycin-C after internal urethrotomy procedure and were conducted in populations with different age means. Each of studies’ quality was assessed using guide from Oxford University Center for Evidence-Based Medicine; this is explained in Table 1 and Table 2 . Table 1. Characteristics of subjects in included studies. Studies Average age (year) Pre-intervention stricture site Procedure of internal urethrotomy Clinical feature Cause of injury MMC group Control group MMC Group Control group Urinary retention Bladder Outlet Obstruction Azotemia Urosepsis Mitomycin-C Group Control group Moradi et al ., 2016 8 54.55 ± 21.25 53.75 ± 24.75 Anterior urethral stricture Trans-urethral incision at 12 o’clock via cold knife urethrotomy N/A N/A Ali et al ., 2015 2 37.31 ± 10.1 40.1 ± 11.4 Bulbar urethra: 84.6% Penile urethra: 15.4% Bulbar urethra: 78.1% Penile urethra: 21.9% Internal Optic urethrotomy Mitomycin-C group Road traffic: 59% Iatrogenic: 30.8% Straddle: 9% Infective: 1.3% Road traffic: 71.2% Iatrogenic: 21.9% Straddle: 6.8% Infective: - 70.5% 16.6% 10.2% 2.5% Control group 57.5% 31.5% 9.5% 1.3% Mazdak et al ., 2007 4 29.8 (15–70) 29.2 (11–66) Anterior urethral stricture Trans- urethral incision at 12 o’clock via cold knife urethrotomy N/A Straddle injury or other blunt perineal trauma Islam et al ., 2019 7 49.43 ± 8.10 48.98±7.20 Anterior urethral stricture Internal Optic Urethrotomy N/A Idiopathic, lichen sclerosus, urethritis, or unknown [i] MMC, mitomycin C. Table 2. Summary and appraisal of the selected articles. Studies LoE Sample size Methods of mitomycin- C application Timing of mitomycin- C application Follow up end- point Validity Importance Applicability Randomized allocation Similarity of group Equal Treatment Minimal Loss to Follow- up Blinding Relevance Feasibility Benefit Overweight the Harm Moradi et al. , 2016 8 1b 40 Intraluminal injection of 0.8 mg mitomycin-C + propylene glycol through indwelling catheter After Internal Urethrotomy 12 months Not stated Yes Yes Yes Not stated RR = 0.20 ARR = 0.40 RRR = 0.80 NNT = 2.5 Unsure Yes Yes Ali et al. , 2015 2 1b 180 Submucosal injection of 0.1% mitomycin- C at three quadrants (1, 11, & 12 o’clock position) using TLA needle After Internal Urethrotomy 18 months Yes No Yes Yes Not stated RR = 0.38 ARR = 0.23 RRR = 0.62 NNT = 4.35 Unsure Yes Yes Mazdak et al. , 2007 4 1b 40 Submucosal injection of 0.1 mg mitomycin- C in four quadrants (1,5,7, & 11 o’clock position) using 22- Gauze cystoscopic needle Before Internal Urethrotomy 6 months Not stated Yes Yes Yes Not stated RR = 0.20 ARR = 0.40 RRR = 0.80 NNT = 2.5 Unsure Yes Yes Islam et al. , 2019 7 1b 80 Submucosal injection of 0.1 mg Mitomycin- C in two quadrants (11 & 1 o’clock) using 21-gauge cystoscopic needle After internal Urethrotomy 6 months Yes Yes Yes Yes Not stated RR = 0.62 ARR = 0.25 RRR = 0.38 NNT = 4 Unsure Yes Yes [i] LoE, level of evidence; RR relative risk; ARR, absolute risk reduction; RRR, relative risk reduction; NNT, number needed to treat. Outcome measures We included the studies in which recurrence was defined by a patient having obstructive symptoms, obvious stricture at retrograde urethrography, or uroflowmetry with maximum flow rate less than 12 mL/s, and stricture was measured using retrograde urethrogram or ultrasonography of the urethra. The outcome that measured was recurrence rate (percentage). Risk of Bias The summary of the risk bias assessment can be found in Figure 2 . All of the studies stated that they have undergone randomization. But only Ali et al . and Islam et al . mentioned the randomization method. A common problem with all the studies included in this review is that there was no clear concealment and blinding statement. All of the studies are completed and have relatively small loss to follow-up rates. Mazdak et al . didn’t mentioned recurrence criteria resulting high risk in selective reporting, but other studies mentioned 2 , 4 , 7 , 8 . Figure 2. Risk of Bias Summary. Results and heterogeneity of the studies All selected articles stated that Mitomycin-C had a significant effect on preventing or delaying urethral stricture recurrence post internal urethrotomy. All studies reported that the time-based recurrence rates in the two groups differed, where lower recurrence rates were found in the group given Mitomycin-C 2 , 4 , 7 , 8 . From study characteristic that is quite different and small number of studies, we choose to use random-effects model in forest plot showed in Figure 3 . This forest plot suggests that there were significant differences between cases and control group. It showed from risk ratio is 0.41 with 95% confidence interval of 0.25 until 0.68, with p value <0.05. As for side effects are reported minimal and insignificant 2 , 8 . Figure 3. Forest plot for recurrence rate. Test for heterogeneity Tau-square = 0.09; chi-square = 4.78; df = 3; p-value = 0.19; I-squared = 37%. Discussion All the studies included in this review treated the two groups equally and had relatively small loss-to-follow-up rates. A common problem with all the studies included in this review is that there was no clear blinding statement. Mazdak et al. 4 and Moradi et al. 8 study stated that their studies are randomized. But, the randomization procedure was not stated in the study method. On the other hand, although Ali et al . 2 had randomized its subjects, age characteristics in the two groups were significantly different. Mazdak et al. 4 also didn’t mentioned recurrence criteria, which could result in high risk bias. There was also a relevant study by Azzawi et al. 9 that matches our inclusion criteria. But we are unable to access the full text, so we decide to exclude it. As for heterogeneity, from the calculation might not be important difference (I 2 =27%, p = 0.19). But the small number of studies, that calculation may not work well. From the studies we could notice the difference in age and methods in administering Mitomycin-C, those difference might add up the heterogeneity. All studies support the use of mitomycin-C to prevent or delay anterior urethral stricture after internal urethrotomy, which in this review defined by a patient having obstructive symptoms, obvious stricture at retrograde urethrography, or uroflowmetry with maximum flow rate less than 12 mL/s, and every stricture in this review are all primary stricture.. This was confirmed by a less rate of recurrence rate in Mitomycin-C patients 2 , 4 , 8 ; we found that those who had Mitomycin-C administered had lower incidence of recurrence during one year and 18 months of follow up (RR = 0.32, P < 0.001). This was also confirmed by a series of cases by Farrell et al. 10 , Farrell et al. 11 , and Sourial et al. 12 Mazdak et al. 4 injected mitomycin-C into the urethral submucosa and reported that patients with mitomycin-C injection had lower rates of stricture recurrence. Opposing this study, some researchers proposed that submucosal injection could increase the complication rate and reduce the duration of the effective dose within the tissue, which yielded a scientific discussion 13 . Ayyildiz et al. 14 assessed the efficacy of Mitomycin-C for preventing urethral scar by applying the agent topically to the traumatized region in rats. They concluded that mitomycin-C applied locally reduced fibrosis significantly in a dose-independent manner. Although all studies support the use of Mitomycin-C to prevent or delay post urethrotomy urethral stricture and the side effects reported in the studies reviewed are minimal, in Ali et al. 2 and Moradi et al. 8 are insignificant, but Mazdak et al. 4 and Islam et al. 7 didn’t asses any side effects, the results of this review need to be followed up with caution. The limitation of this study can be seen from only a few studies that discuss this topic. Some of the existing studies are not enough to be generalized to a wider population, given that selected studies were carried out in Iran and Pakistan 2 , 4 , 7 , 8 . Therefore their application needs to be carried out wisely and cautiously. Research related to this in the future can still be done with different populations. Due to short period of follow up time in all studies, some authors 2 , 4 concluded that the study of Mitomycin-C needed firm results regarding long term success. Mazdak et al. 4 added that stricture may recur within two years after internal urethrotomy. Conclusion Mitomycin-C could be used as a potential additional treatment for anterior urethral strictures after internal urethrotomy. However, further studies are required to investigate the safety and efficacy of this method for treating anterior urethral strictures, as only a limited number of studies presently exist. Data availability Underlying data All data underlying the results are available as part of the article and no additional source data are required. Reporting guidelines Open Science Framework: PRISMA checklist for ‘Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis’. https://doi.org/10.17605/OSF.IO/APU9B 15 . The updated PRISMA checklist is available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication). Faculty Opinions recommended References 1. Zaid UB, Lavien G, Peterson AC: Management of the Recurrent Male Urethral Stricture. Curr Urol Rep. 2016; 17 (4): 33. PubMed Abstract | Publisher Full Text 2. Ali L, Shahzad M, Orakzai N, et al. : Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy. Korean J Urol. 2015; 56 (9): 650–5. PubMed Abstract | Publisher Full Text | Free Full Text 3. McCammon K, Zuckerman J, Jordan G: Surgery of the penis and urethra. In: Wein AJ, Kavoussi LR, Partin AW, eds. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier; 2016; 938. Publisher Full Text 4. Mazdak H, Meshki I, Ghassami F: Effect of mitomycin C on anterior urethral stricture recurrence after internal urethrotomy. Eur Urol. 2007; 51 (4): 1089–92. PubMed Abstract | Publisher Full Text 5. Su C, Sui T, Zhang X, et al. : Effect of topical application of mitomycin-C on wound healing in a postlaminectomy rat model: an experimental study. Eur J Pharmacol. 2012; 674 (1): 7–12. PubMed Abstract | Publisher Full Text 6. Critical appraisal for randomized controlled trial. Center of Evidence-Based Medicine University of Oxford; 2019. 7. Islam SU, Baloch WA, Shahid MA, et al. : Role of Mitomycin C in Anterior Urethral Stricture Recurrence after Internal Urethrotomy. Pak J Med Health Sci. 2019; 13 (2): 497–9. Reference Source 8. Moradi M, Derakhshandeh K, Karimian B, et al. : Safety and efficacy of Intraurethral Mitomycin C Hydrogel for prevention of post-traumatic anterior urethral stricture recurrence after internal urethrotomy. J Inj Violence Res. 2016; 8 (2): 75–9. PubMed Abstract | Publisher Full Text | Free Full Text 9. Azzawi IA: [15] The role of mitomycin C intralesional injection during visual internal urethrotomy in urethral stricture recurrence. Arab Journal of Urology. 2018; 16 (sup1): S8–S9. Publisher Full Text 10. Farrell MR, Lawrenz CW, Levine LA: Internal Urethrotomy With Intralesional Mitomycin C: An Effective Option for Endoscopic Management of Recurrent Bulbar and Bulbomembranous Urethral Strictures. Urology. 2017; 110 : 223–7. PubMed Abstract | Publisher Full Text 11. Farrell MR, Sherer BA, Levine LA: Visual Internal Urethrotomy With Intralesional Mitomycin C and Short-term Clean Intermittent Catheterization for the Management of Recurrent Urethral Strictures and Bladder Neck Contractures. Urology. 2015; 85 (6): 1494–9. PubMed Abstract | Publisher Full Text 12. Sourial MW, Richard PO, Bettez M, et al. : Mitomycin-C and urethral dilatation: A safe, effective, and minimally invasive procedure for recurrent vesicourethral anastomotic stenoses. Urol Oncol. 2017; 35 (12): 672.e15–672.e19. PubMed Abstract | Publisher Full Text 13. Estrem SA, Vanleeuwen RN: Use of Mitomycin C for maintaining myringotomy patency. Otolaryngol Head Neck Surg. 2000; 122 (1): 8–10. PubMed Abstract | Publisher Full Text 14. Ayyildiz A, Nuhoglu B, Gülerkaya B, et al. : Effect of intraurethral Mitomycin-C on healing and fibrosis in rats with experimentally induced urethral stricture. Int J Urol. 2004; 11 (12): 1122–6. PubMed Abstract | Publisher Full Text 15. Andy: PRISMA Checklist - Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis. 2019. http://www.doi.org/10.17605/OSF.IO/APU9B Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 08 Aug 2019 ADD YOUR COMMENT Comment Author details Author details 1 Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia Gampo Alam Irdam Roles: Conceptualization, Methodology, Writing – Review & Editing Irfan Wahyudi Roles: Conceptualization, Data Curation, Methodology, Supervision, Writing – Review & Editing Andy Andy Roles: Conceptualization, Formal Analysis, Investigation, Validation, Writing – Original Draft Preparation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 10 Aug 2020, 8:1390 https://doi.org/10.12688/f1000research.19704.3 version 2 Revised Published: 03 Jun 2020, 8:1390 https://doi.org/10.12688/f1000research.19704.2 version 1 Published: 08 Aug 2019, 8:1390 https://doi.org/10.12688/f1000research.19704.1 Copyright © 2020 Irdam GA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Irdam GA, Wahyudi I and Andy A. Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.12688/f1000research.19704.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 10 Aug 2020 Revised Views 0 Cite How to cite this report: Dönmez Mİ. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.28494.r157926 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v3#referee-response-157926 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Jan 2023 Muhammet İrfan Dönmez , Istanbul University, Istanbul, Turkey Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.28494.r157926 In this study, the authors aimed to investigate the efficacy of Mitomycin-C in adult patients with anterior urethral stricture after internal urethrotomy. Three studies involving 311 patients were included and a systematic review was conducted. However, I do have some ... Continue reading READ ALL In this study, the authors aimed to investigate the efficacy of Mitomycin-C in adult patients with anterior urethral stricture after internal urethrotomy. Three studies involving 311 patients were included and a systematic review was conducted. However, I do have some questions and concerns outlined below about their study. According to abstract, three studies involving 311 patients were included in this review. However, flowchart indicates that four articles were included. Please clarify. The search was done in March 15th 2020. If there are other current studies from the last two years, I believe that they should be updated, as well. The review mentioned different usage and dosage of submucosal injection of mitomycin-C in four studies. Is it possible to give an opinion to the reader about which application method is more ideal? The difference and heterogeneity in age and methods in administering Mitomycin-C may cause misinterpretation of the results. We included the studies in which ...... recurrence was defined .... uroflowmetry with maximum flow rate less than 12 mL/s . What are the references that the mentioned studies use to determine this threshold value? There was no assessment of side effects in two of the studies. In addition, the lack of clear concealment and blinding statement in all four studies included in this systematic review increases the risk of bias. Further, the time to recurrence cannot be clearly evaluated due to short follow-up period. This raises doubts about the reliability of the study outcomes. As a result, the main limitation of this systematic review is that the results cannot be generalized to a wider population as it only included a few studies. Based on this, giving the message in the conclusion that Mitomycin-C has potential for efficacy in the treatment of anterior urethral stricture after internal urethrotomy may mislead the reader. There several errors of grammar and syntax that need attention. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: urethral stricture I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Dönmez Mİ. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.28494.r157926 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v3#referee-response-157926 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: de Kort LMO. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.28494.r69072 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v3#referee-response-69072 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 18 Aug 2020 Laetitia M. O. de Kort , University Medical Centre Utrecht, Utrecht, The Netherlands Approved VIEWS 0 https://doi.org/10.5256/f1000research.28494.r69072 I am satisfied ... Continue reading READ ALL I am satisfied with the adjustments. Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT de Kort LMO. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.28494.r69072 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v3#referee-response-69072 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 03 Jun 2020 Revised Views 0 Cite How to cite this report: Shokraneh F. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.26186.r64256 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v2#referee-response-64256 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 29 Jun 2020 Farhad Shokraneh , King's College London, London, UK Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.26186.r64256 I thank the authors for applying a few of my suggestions: Running an update search and adding one of my suggested studies; Changing the Fixed-Effect Model to Random-Effects Model (Effects not ... Continue reading READ ALL I thank the authors for applying a few of my suggestions: Running an update search and adding one of my suggested studies; Changing the Fixed-Effect Model to Random-Effects Model (Effects not Effect); Balancing their conclusion. The manuscript can benefit from a native language editor. Unfortunately, the majority of the comments and concerns are still standing: revising search strategy involving a search expert, restructuring inclusion and exclusion criteria, reporting/listing/analysing side effects as outcomes, adding new text headings in Methods for screening, data extraction, assessment of risk of bias, and explaining the processes that require involving at least two reviewer, following PRISMA checklist items, discussing the results of heterogeneity test, removing first four paragraphs from discussion or moving them to introduction, and assessing, including or citing Azzawi's study or mentioning the reason for its exclusion. The authors have removed EBSCOhost and Ovid rather than mentioning the names of the listed of searched databases via these search interfaces. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Evidence Synthesis, Systematic Review, Information Retrieval, Automation of Systematic Reviews, Living Evidence, Scoping Review, Cochrane Review, Database, Clinical Practice Guideline, Overview, Rapid Review, Randomized Controlled Trial, Open Data, Medical Journalism, Outcome, Intervention, Cochrane. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Shokraneh F. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.26186.r64256 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v2#referee-response-64256 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Aug 2020 Andy Andy , Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia 10 Aug 2020 Author Response Thank you for your feedback, I really appreciate it. As for the method section and other feedbacks we’ll be revising it. As for the journal database, we have changed from ... Continue reading Thank you for your feedback, I really appreciate it. As for the method section and other feedbacks we’ll be revising it. As for the journal database, we have changed from OVID and EBSCOHost with MEDLINE. Thank you for your feedback, I really appreciate it. As for the method section and other feedbacks we’ll be revising it. As for the journal database, we have changed from OVID and EBSCOHost with MEDLINE. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Aug 2020 Andy Andy , Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia 10 Aug 2020 Author Response Thank you for your feedback, I really appreciate it. As for the method section and other feedbacks we’ll be revising it. As for the journal database, we have changed from ... Continue reading Thank you for your feedback, I really appreciate it. As for the method section and other feedbacks we’ll be revising it. As for the journal database, we have changed from OVID and EBSCOHost with MEDLINE. Thank you for your feedback, I really appreciate it. As for the method section and other feedbacks we’ll be revising it. As for the journal database, we have changed from OVID and EBSCOHost with MEDLINE. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: de Kort LMO. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.26186.r64255 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v2#referee-response-64255 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 18 Jun 2020 Laetitia M. O. de Kort , University Medical Centre Utrecht, Utrecht, The Netherlands Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.26186.r64255 My comments: The length of the stricture is important indeed and should not be ... Continue reading READ ALL My comments: The length of the stricture is important indeed and should not be left out. Still the definition of stricture recurrence is not mentioned in the discussion. Side effects and adverse events are still not mentioned. Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT de Kort LMO. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.26186.r64255 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v2#referee-response-64255 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Aug 2020 Andy Andy , Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia 10 Aug 2020 Author Response Thank you for the feedback again. We really appreciate it. For the length of stricture after critical reading over the references, only Mazdak et al compare the length of the ... Continue reading Thank you for the feedback again. We really appreciate it. For the length of stricture after critical reading over the references, only Mazdak et al compare the length of the stricture. Meanwhile, others did not compare it even with the newest reference. The definition of stricture recurrence has been mentioned in outcome measures inside the result section, but I will add it to the discussion. As for side effects and adverse events that have been mentioned in the seventh paragraph and the references didn't mention specific side effects nor adverse events, they only mention insignificant and minimal. Thank you for the feedback again. We really appreciate it. For the length of stricture after critical reading over the references, only Mazdak et al compare the length of the stricture. Meanwhile, others did not compare it even with the newest reference. The definition of stricture recurrence has been mentioned in outcome measures inside the result section, but I will add it to the discussion. As for side effects and adverse events that have been mentioned in the seventh paragraph and the references didn't mention specific side effects nor adverse events, they only mention insignificant and minimal. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Aug 2020 Andy Andy , Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia 10 Aug 2020 Author Response Thank you for the feedback again. We really appreciate it. For the length of stricture after critical reading over the references, only Mazdak et al compare the length of the ... Continue reading Thank you for the feedback again. We really appreciate it. For the length of stricture after critical reading over the references, only Mazdak et al compare the length of the stricture. Meanwhile, others did not compare it even with the newest reference. The definition of stricture recurrence has been mentioned in outcome measures inside the result section, but I will add it to the discussion. As for side effects and adverse events that have been mentioned in the seventh paragraph and the references didn't mention specific side effects nor adverse events, they only mention insignificant and minimal. Thank you for the feedback again. We really appreciate it. For the length of stricture after critical reading over the references, only Mazdak et al compare the length of the stricture. Meanwhile, others did not compare it even with the newest reference. The definition of stricture recurrence has been mentioned in outcome measures inside the result section, but I will add it to the discussion. As for side effects and adverse events that have been mentioned in the seventh paragraph and the references didn't mention specific side effects nor adverse events, they only mention insignificant and minimal. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 08 Aug 2019 Views 0 Cite How to cite this report: Shokraneh F. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.21610.r59109 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v1#referee-response-59109 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Feb 2020 Farhad Shokraneh , King's College London, London, UK Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.21610.r59109 The authors have conducted the first systematic review to answer this research question. It is a valuable effort. Abstract EBSCOhost and Ovid are not databases. They are search interfaces or search engines for ... Continue reading READ ALL The authors have conducted the first systematic review to answer this research question. It is a valuable effort. Abstract EBSCOhost and Ovid are not databases. They are search interfaces or search engines for other databases. Please add the name of the databases that you search using these two tools. Please add the exact search date (dd/mm/yyyy). Please state the reason for not using Cochrane Risk of Bias tool for assessing risk of bias of RCTs. Please add rationale for using fixed effect model. The conclusion is so strong. With limited evidence, it is not easy to say that MMC has safety, efficacy, or long-term efficacy. Methods The search date is older than a year (17 months old). Please update the search. I spent a few minutes and identified following recent studies: - Azzawi (2018) 1 - Islam et al. (2019) 2 EBSCOhost and Ovid are not databases. They are search interfaces or search engines for other databases. Please add the name of the databases that you search using these two tools. The search strategy reported for PubMed needs serious attention by a search expert such as a librarian or information specialist and through using PRESS checklist for peer-reviewing search strategies. If authors have no access to such person they can post a task on taskexchange.cochrane.org and request a volunteer to help them in exchange to offering Acknowledgement or Authorship, depending on their contribution. When the number of results is little, usually the authors should seek other sources such as references of included studies, citations to relevant studies, contacting the authors of relevant studies, etc. Depending on amount of time and resources available for the team, I request them to use other methods to make sure no studies are missing. Please structure Inclusion and Exclusion Criteria to subheadings: Patients, Intervention, Control/Comparison, and Primary and Secondary Outcomes. I wondered why side effects of interventions have not been listed as collected outcome data. Please add separate headings for Screening, Data Extraction, Assessment of Risk of Bias, and explain their processes. Please follow the PRISMA reporting guideline items one by one. Please state the reason for not using Cochrane Risk of Bias tool for assessing risk of bias of RCTs while it is available within RevMan. Please share your RevMan file as Appendix in Open Science Framework so that the readers could reproduce your analysis. Please add rationale for using fixed effect model. Results Please follow the original PRISMA flow diagram in which duplication is before screening. I2 is not the only way to notice heterogeneity. Actually, I2 may not work well with small sample size and low number of studies. The other ways is to look at the heterogeneity in study details such as characteristics of population (age – compare Age in Moradi with age in Mazdak –, sex, etc.), interventions (method of administration or dosage), and outcomes (methods of measurement). Also N/As in the table are missing details that you may get contacting the authors and they may contribute to heterogeneity. Based on what I see in your description, the method of administration is different among studies plus age of the patients varies across studies. Discussion The first four paragraph of the discussion are not discussing the results and they seem to be relevant to Background. Impact of small sample size, heterogeneity of included studies, adverse effects, subjectivity of outcome measure, not using placebo for control group on interpreting these results are some of the items that could have been discussed here. I also refer the authors to a commentary written by Ng and Chan on Mazdak et al . as the first RCT 3 . I thank the authors for listing some of the limitations this reviews. I think a new version of this review should be submitted, before being approved. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? No Is the statistical analysis and its interpretation appropriate? Partly Are the conclusions drawn adequately supported by the results presented in the review? No References 1. Azzawi I: [15] The role of mitomycin C intralesional injection during visual internal urethrotomy in urethral stricture recurrence. Arab Journal of Urology . 2018; 16 (sup1): S8-S9 Publisher Full Text 2. Islam SU, Baloch WA, Shahid MA, Ansari I, et al.: Role of Mitomycin C in Anterior Urethral Stricture Recurrence after Internal Urethrotomy. Pakistan Journal of Medical and Health Sciences . 2019; 13 (2): 497-499 3. Ng C, Chan S: Re: Hamid Mazdak, Iraj Meshki and Fatemeh Ghassami. Effect of Mitomycin C on Anterior Urethral Stricture Recurrence after Internal Urethrotomy. Eur Urol 2007;51:1089–92. European Urology . 2007; 52 (3). Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Evidence Synthesis, Systematic Review, Information Retireval, Automation of Systematic Reviews, Living Evidence, Scoping Review, Cochrane Review, Database, Clinical Practice Guideline, Overview, Rapid Review, Randomized Controlled Trial, Open Data, Medical Journalism, Outcome, Intervention, Cochrane. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Shokraneh F. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.21610.r59109 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v1#referee-response-59109 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 03 Jun 2020 Andy Andy , Indonesia University, Urology Department, Indonesia 03 Jun 2020 Author Response Thank you for the feedback, we have revised according to most of your comments. Update also has been implemented. As for contacting the authors for N/A in tables, we have ... Continue reading Thank you for the feedback, we have revised according to most of your comments. Update also has been implemented. As for contacting the authors for N/A in tables, we have tried contacting the authors but there is no answer until now. Thank you for the feedback, we have revised according to most of your comments. Update also has been implemented. As for contacting the authors for N/A in tables, we have tried contacting the authors but there is no answer until now. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 03 Jun 2020 Andy Andy , Indonesia University, Urology Department, Indonesia 03 Jun 2020 Author Response Thank you for the feedback, we have revised according to most of your comments. Update also has been implemented. As for contacting the authors for N/A in tables, we have ... Continue reading Thank you for the feedback, we have revised according to most of your comments. Update also has been implemented. As for contacting the authors for N/A in tables, we have tried contacting the authors but there is no answer until now. Thank you for the feedback, we have revised according to most of your comments. Update also has been implemented. As for contacting the authors for N/A in tables, we have tried contacting the authors but there is no answer until now. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: de Kort LMO. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.21610.r59108 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v1#referee-response-59108 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Feb 2020 Laetitia M. O. de Kort , University Medical Centre Utrecht, Utrecht, The Netherlands Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.21610.r59108 The subject of this review is interesting and relevant to clinical practice. The review is well written. I have some comments: The literature search was until September 2018. Why is an update missing? ... Continue reading READ ALL The subject of this review is interesting and relevant to clinical practice. The review is well written. I have some comments: The literature search was until September 2018. Why is an update missing? Complications and side effects of the MMC injections were not mentioned. There was no clear definition of recurrence of the stricture. As this is a major subject of dispute in urethral surgery, this issue should be addressed, at least in the discussion. The length of the stricture was not mentioned. Were these all primary strictures? Should be addressed. The first publication was in 2007. Yet, MMC injection is not implemented in clinical practice for prevention of urethral stricture. It should be discussed why this is the case. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Partly Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Partly Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT de Kort LMO. Reviewer Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.21610.r59108 ) The direct URL for this report is: https://f1000research.com/articles/8-1390/v1#referee-response-59108 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 03 Apr 2020 Andy Andy , Indonesia University, Urology Department, Indonesia 03 Apr 2020 Author Response Thank you for your review. We have revised our publication according to your comments and we will upload it as soon as possible. But some comments I would like to ... Continue reading Thank you for your review. We have revised our publication according to your comments and we will upload it as soon as possible. But some comments I would like to answer them The literature search was until September 2018. Why is an update missing? We have searched with our search strategy and there are no updates until September 2018. The first publication was in 2007. Yet, MMC injection is not implemented in clinical practice for prevention of urethral stricture. It should be discussed why this is the case. It has been stated clearly that the evidence for MMC injections are not enough for it to be implemented in clinical practice. Therefore, we require further research. We are open to any suggestion for improving this study, thank you Thank you for your review. We have revised our publication according to your comments and we will upload it as soon as possible. But some comments I would like to answer them The literature search was until September 2018. Why is an update missing? We have searched with our search strategy and there are no updates until September 2018. The first publication was in 2007. Yet, MMC injection is not implemented in clinical practice for prevention of urethral stricture. It should be discussed why this is the case. It has been stated clearly that the evidence for MMC injections are not enough for it to be implemented in clinical practice. Therefore, we require further research. We are open to any suggestion for improving this study, thank you Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 03 Apr 2020 Andy Andy , Indonesia University, Urology Department, Indonesia 03 Apr 2020 Author Response Thank you for your review. We have revised our publication according to your comments and we will upload it as soon as possible. But some comments I would like to ... Continue reading Thank you for your review. We have revised our publication according to your comments and we will upload it as soon as possible. But some comments I would like to answer them The literature search was until September 2018. Why is an update missing? We have searched with our search strategy and there are no updates until September 2018. The first publication was in 2007. Yet, MMC injection is not implemented in clinical practice for prevention of urethral stricture. It should be discussed why this is the case. It has been stated clearly that the evidence for MMC injections are not enough for it to be implemented in clinical practice. Therefore, we require further research. We are open to any suggestion for improving this study, thank you Thank you for your review. We have revised our publication according to your comments and we will upload it as soon as possible. But some comments I would like to answer them The literature search was until September 2018. Why is an update missing? We have searched with our search strategy and there are no updates until September 2018. The first publication was in 2007. Yet, MMC injection is not implemented in clinical practice for prevention of urethral stricture. It should be discussed why this is the case. It has been stated clearly that the evidence for MMC injections are not enough for it to be implemented in clinical practice. Therefore, we require further research. We are open to any suggestion for improving this study, thank you Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 08 Aug 2019 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 3 (revision) 10 Aug 20 read read Version 2 (revision) 03 Jun 20 read read Version 1 08 Aug 19 read read Laetitia M. O. de Kort , University Medical Centre Utrecht, Utrecht, The Netherlands Farhad Shokraneh , King's College London, London, UK Muhammet İrfan Dönmez , Istanbul University, Istanbul, Turkey Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 Dönmez M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Jan 2023 | for Version 3 Muhammet İrfan Dönmez , Istanbul University, Istanbul, Turkey 0 Views copyright © 2023 Dönmez M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions In this study, the authors aimed to investigate the efficacy of Mitomycin-C in adult patients with anterior urethral stricture after internal urethrotomy. Three studies involving 311 patients were included and a systematic review was conducted. However, I do have some questions and concerns outlined below about their study. According to abstract, three studies involving 311 patients were included in this review. However, flowchart indicates that four articles were included. Please clarify. The search was done in March 15th 2020. If there are other current studies from the last two years, I believe that they should be updated, as well. The review mentioned different usage and dosage of submucosal injection of mitomycin-C in four studies. Is it possible to give an opinion to the reader about which application method is more ideal? The difference and heterogeneity in age and methods in administering Mitomycin-C may cause misinterpretation of the results. We included the studies in which ...... recurrence was defined .... uroflowmetry with maximum flow rate less than 12 mL/s . What are the references that the mentioned studies use to determine this threshold value? There was no assessment of side effects in two of the studies. In addition, the lack of clear concealment and blinding statement in all four studies included in this systematic review increases the risk of bias. Further, the time to recurrence cannot be clearly evaluated due to short follow-up period. This raises doubts about the reliability of the study outcomes. As a result, the main limitation of this systematic review is that the results cannot be generalized to a wider population as it only included a few studies. Based on this, giving the message in the conclusion that Mitomycin-C has potential for efficacy in the treatment of anterior urethral stricture after internal urethrotomy may mislead the reader. There several errors of grammar and syntax that need attention. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise urethral stricture I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Dönmez Mİ. Peer Review Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.28494.r157926) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/8-1390/v3#referee-response-157926 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2020 de Kort L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 18 Aug 2020 | for Version 3 Laetitia M. O. de Kort , University Medical Centre Utrecht, Utrecht, The Netherlands 0 Views copyright © 2020 de Kort L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I am satisfied with the adjustments. Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) de Kort LMO. Peer Review Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.28494.r69072) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/8-1390/v3#referee-response-69072 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2020 Shokraneh F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 29 Jun 2020 | for Version 2 Farhad Shokraneh , King's College London, London, UK 0 Views copyright © 2020 Shokraneh F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I thank the authors for applying a few of my suggestions: Running an update search and adding one of my suggested studies; Changing the Fixed-Effect Model to Random-Effects Model (Effects not Effect); Balancing their conclusion. The manuscript can benefit from a native language editor. Unfortunately, the majority of the comments and concerns are still standing: revising search strategy involving a search expert, restructuring inclusion and exclusion criteria, reporting/listing/analysing side effects as outcomes, adding new text headings in Methods for screening, data extraction, assessment of risk of bias, and explaining the processes that require involving at least two reviewer, following PRISMA checklist items, discussing the results of heterogeneity test, removing first four paragraphs from discussion or moving them to introduction, and assessing, including or citing Azzawi's study or mentioning the reason for its exclusion. The authors have removed EBSCOhost and Ovid rather than mentioning the names of the listed of searched databases via these search interfaces. Competing Interests No competing interests were disclosed. Reviewer Expertise Evidence Synthesis, Systematic Review, Information Retrieval, Automation of Systematic Reviews, Living Evidence, Scoping Review, Cochrane Review, Database, Clinical Practice Guideline, Overview, Rapid Review, Randomized Controlled Trial, Open Data, Medical Journalism, Outcome, Intervention, Cochrane. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 10 Aug 2020 Andy Andy, Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia Thank you for your feedback, I really appreciate it. As for the method section and other feedbacks we’ll be revising it. As for the journal database, we have changed from OVID and EBSCOHost with MEDLINE. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Shokraneh F. Peer Review Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.26186.r64256) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/8-1390/v2#referee-response-64256 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2020 de Kort L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 18 Jun 2020 | for Version 2 Laetitia M. O. de Kort , University Medical Centre Utrecht, Utrecht, The Netherlands 0 Views copyright © 2020 de Kort L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions My comments: The length of the stricture is important indeed and should not be left out. Still the definition of stricture recurrence is not mentioned in the discussion. Side effects and adverse events are still not mentioned. Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 10 Aug 2020 Andy Andy, Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia Thank you for the feedback again. We really appreciate it. For the length of stricture after critical reading over the references, only Mazdak et al compare the length of the stricture. Meanwhile, others did not compare it even with the newest reference. The definition of stricture recurrence has been mentioned in outcome measures inside the result section, but I will add it to the discussion. As for side effects and adverse events that have been mentioned in the seventh paragraph and the references didn't mention specific side effects nor adverse events, they only mention insignificant and minimal. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern de Kort LMO. Peer Review Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.26186.r64255) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/8-1390/v2#referee-response-64255 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2020 Shokraneh F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Feb 2020 | for Version 1 Farhad Shokraneh , King's College London, London, UK 0 Views copyright © 2020 Shokraneh F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have conducted the first systematic review to answer this research question. It is a valuable effort. Abstract EBSCOhost and Ovid are not databases. They are search interfaces or search engines for other databases. Please add the name of the databases that you search using these two tools. Please add the exact search date (dd/mm/yyyy). Please state the reason for not using Cochrane Risk of Bias tool for assessing risk of bias of RCTs. Please add rationale for using fixed effect model. The conclusion is so strong. With limited evidence, it is not easy to say that MMC has safety, efficacy, or long-term efficacy. Methods The search date is older than a year (17 months old). Please update the search. I spent a few minutes and identified following recent studies: - Azzawi (2018) 1 - Islam et al. (2019) 2 EBSCOhost and Ovid are not databases. They are search interfaces or search engines for other databases. Please add the name of the databases that you search using these two tools. The search strategy reported for PubMed needs serious attention by a search expert such as a librarian or information specialist and through using PRESS checklist for peer-reviewing search strategies. If authors have no access to such person they can post a task on taskexchange.cochrane.org and request a volunteer to help them in exchange to offering Acknowledgement or Authorship, depending on their contribution. When the number of results is little, usually the authors should seek other sources such as references of included studies, citations to relevant studies, contacting the authors of relevant studies, etc. Depending on amount of time and resources available for the team, I request them to use other methods to make sure no studies are missing. Please structure Inclusion and Exclusion Criteria to subheadings: Patients, Intervention, Control/Comparison, and Primary and Secondary Outcomes. I wondered why side effects of interventions have not been listed as collected outcome data. Please add separate headings for Screening, Data Extraction, Assessment of Risk of Bias, and explain their processes. Please follow the PRISMA reporting guideline items one by one. Please state the reason for not using Cochrane Risk of Bias tool for assessing risk of bias of RCTs while it is available within RevMan. Please share your RevMan file as Appendix in Open Science Framework so that the readers could reproduce your analysis. Please add rationale for using fixed effect model. Results Please follow the original PRISMA flow diagram in which duplication is before screening. I2 is not the only way to notice heterogeneity. Actually, I2 may not work well with small sample size and low number of studies. The other ways is to look at the heterogeneity in study details such as characteristics of population (age – compare Age in Moradi with age in Mazdak –, sex, etc.), interventions (method of administration or dosage), and outcomes (methods of measurement). Also N/As in the table are missing details that you may get contacting the authors and they may contribute to heterogeneity. Based on what I see in your description, the method of administration is different among studies plus age of the patients varies across studies. Discussion The first four paragraph of the discussion are not discussing the results and they seem to be relevant to Background. Impact of small sample size, heterogeneity of included studies, adverse effects, subjectivity of outcome measure, not using placebo for control group on interpreting these results are some of the items that could have been discussed here. I also refer the authors to a commentary written by Ng and Chan on Mazdak et al . as the first RCT 3 . I thank the authors for listing some of the limitations this reviews. I think a new version of this review should be submitted, before being approved. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? No Is the statistical analysis and its interpretation appropriate? Partly Are the conclusions drawn adequately supported by the results presented in the review? No References 1. Azzawi I: [15] The role of mitomycin C intralesional injection during visual internal urethrotomy in urethral stricture recurrence. Arab Journal of Urology . 2018; 16 (sup1): S8-S9 Publisher Full Text 2. Islam SU, Baloch WA, Shahid MA, Ansari I, et al.: Role of Mitomycin C in Anterior Urethral Stricture Recurrence after Internal Urethrotomy. Pakistan Journal of Medical and Health Sciences . 2019; 13 (2): 497-499 3. Ng C, Chan S: Re: Hamid Mazdak, Iraj Meshki and Fatemeh Ghassami. Effect of Mitomycin C on Anterior Urethral Stricture Recurrence after Internal Urethrotomy. Eur Urol 2007;51:1089–92. European Urology . 2007; 52 (3). Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Evidence Synthesis, Systematic Review, Information Retireval, Automation of Systematic Reviews, Living Evidence, Scoping Review, Cochrane Review, Database, Clinical Practice Guideline, Overview, Rapid Review, Randomized Controlled Trial, Open Data, Medical Journalism, Outcome, Intervention, Cochrane. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 03 Jun 2020 Andy Andy, Indonesia University, Urology Department, Indonesia Thank you for the feedback, we have revised according to most of your comments. Update also has been implemented. As for contacting the authors for N/A in tables, we have tried contacting the authors but there is no answer until now. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Shokraneh F. Peer Review Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.21610.r59109) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/8-1390/v1#referee-response-59109 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2020 de Kort L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Feb 2020 | for Version 1 Laetitia M. O. de Kort , University Medical Centre Utrecht, Utrecht, The Netherlands 0 Views copyright © 2020 de Kort L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The subject of this review is interesting and relevant to clinical practice. The review is well written. I have some comments: The literature search was until September 2018. Why is an update missing? Complications and side effects of the MMC injections were not mentioned. There was no clear definition of recurrence of the stricture. As this is a major subject of dispute in urethral surgery, this issue should be addressed, at least in the discussion. The length of the stricture was not mentioned. Were these all primary strictures? Should be addressed. The first publication was in 2007. Yet, MMC injection is not implemented in clinical practice for prevention of urethral stricture. It should be discussed why this is the case. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Partly Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Partly Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 03 Apr 2020 Andy Andy, Indonesia University, Urology Department, Indonesia Thank you for your review. We have revised our publication according to your comments and we will upload it as soon as possible. But some comments I would like to answer them The literature search was until September 2018. Why is an update missing? We have searched with our search strategy and there are no updates until September 2018. The first publication was in 2007. Yet, MMC injection is not implemented in clinical practice for prevention of urethral stricture. It should be discussed why this is the case. It has been stated clearly that the evidence for MMC injections are not enough for it to be implemented in clinical practice. Therefore, we require further research. We are open to any suggestion for improving this study, thank you View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern de Kort LMO. Peer Review Report For: Efficacy of mitomycin-C on anterior urethral stricture after internal urethrotomy: A systematic review and meta-analysis [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2020, 8 :1390 ( https://doi.org/10.5256/f1000research.21610.r59108) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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