To identify the frequency of de novo SUI after posterior excision and primary anastomotic (EPA) urethroplasty in patients with radiation-induced urethral strictures (RIUS) and compare to patients with pelvic fracture urethral injuries (PFUI).
A retrospective review was conducted among patients who underwent successful posterior EPA urethroplasty between 2008 and 2016 for RIUS from prostate cancer or PFUI from blunt trauma. Only patients with an intact bladder neck on imaging were included. SUI was defined by patient reported outcomes and daily pad use.
Inclusion criteria were met by 36 RIUS and 33 PFUI patients. Among the RIUS cohort, mean follow up was 18 months, mean stricture length was 2.5 cm, and surgical dissection extended to the prostatic urethra in 67% (n=24). The overall frequency of de novo SUI among RIUS patients was 33% (n=12), of which 75% (9/12) had prostatic urethral involvement. Two RIUS patients, (17%, n=12) proceeded with artificial urinary sphincter (AUS) placement while the remaining 10 patients required pads. SUI following urethroplasty in PFUI patients was less common (12%, n=4) and the prostatic urethra was involved in only 3% (n=1) of all PFUI patients. One PFUI patient underwent AUS placement while the remaining 3 patients did not require pads.
Among RIUS patients with an intact bladder neck, SUI impacts one third of patients. Subsequent AUS placement is uncommon. Prostatic urethral involvement increases risk of SUI. SUI is less common among PFUI patients, likely related to more a limited involvement of the proximal bulbomembranous urethra and lack of radiation.
Urology. 2017 Nov 27 [Epub ahead of print]
Paul H Chung, Paige Esposito, Hunter Wessells, Bryan B Voelzke
Department of Urology, University of Washington School of Medicine. Electronic address: ., University of Washington Medical Center, Seattle, WA, USA., Department of Urology, University of Washington School of Medicine.