PURPOSE: We recently demonstrated that radiotherapy-induced urethral strictures can be successfully managed with urethroplasty.
We increased size and follow-up on our multi-institutional cohort and evaluated excision and primary anastomosis (EPA) as treatment for radiotherapy-induced urethral strictures.
MATERIALS AND METHODS: A retrospective review of 72 patients treated for radiotherapy-induced bulbomembranous strictures from three academic institutions was performed. Outcome parameters of successful repair included recurrence, incontinence, and erectile dysfunction.
RESULTS AND LIMITATIONS: Among 72 men treated for radiotherapy-induced strictures, 66 (91.7%) underwent EPA. Mean follow-up was 3.5 years (median 3.1, range 0.8-11.2 years). Prostate cancer was the most common reason for radiotherapy (64/66, 96.9%); external beam radiotherapy and brachytherapy was performed in 28/66 men (42.4%) each, a combination of both in 9 (13.6%). Mean time from radiation to EPA was 6.4 years (range 1-20), mean stricture length 2.3 cm (range 1 to 6). Successful reconstruction was achieved in 46 men (69.7%). Mean time to recurrence was 10.2 months (range 1 to 64), with new onset of incontinence observed in 12 men (18.5%); this was associated with stricture length >2cm (p=0.013) and center of treatment (p< 0.001). The rate of erectile dysfunction remained stable (45.6% preoperative, 50.9% postoperative, p=0.71). Type of radiotherapy did not affect stricture length (p=0.41), recurrence risk (p=0.91), post-op incontinence (p=0.88), or erectile dysfunction (p=0.53).
CONCLUSIONS: Radiotherapy-induced bulbomembranous urethral strictures can be successfully managed with EPA. Substitution urethroplasty with graft or flap is infrequently needed. Patients should be counseled on the potential risks of urinary incontinence and erectile dysfunction.
Written by:
Hofer MD, Zhao LC, Morey AF, Scott JF, Chang AJ, Brandes SB, Gonzalez CM. Are you the author?
Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL; Department of Urology, UT Southwestern, Dallas, TX; Department of Urology, Washington University, St. Louis, MO.
Reference: J Urol. 2013 Dec 11. pii: S0022-5347(13)06091-6.
doi: 10.1016/j.juro.2013.10.147
PubMed Abstract
PMID: 24333513
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