To estimate the efficacy of urethroplasty and rates of de novo stress urinary incontinence (SUI) in the specific setting of radiation-induced urethral stenosis (RIUS).
A systematic search of databases (PubMed and EMBASE) was performed between 1980-2019 (CRD42020144845). Inclusion criteria were: (1) prior pelvic radiotherapy; (2) surgical urethroplasty; (3) rates of successful treatment and/or SUI development and (4) total case number provided. The pooled summary of stenosis resolution rate and SUI were calculated using the random-effects model weighted by the inverse variance. Accessory analyses were performed by reconstructive technique and type of RT.
Ninety-six studies were identified, of which 8 retrospective studies met inclusion criteria, comprising 256 patients. The proportion of cases treated with external beam RT (EBRT), brachytherapy (BT), or combination (EBRT+BT) were 52%, 33%, and 15%, respectively, of studies that specified modality. Most strictures involved the bulbomembranous region (n=212; 83%). Sixty-one percent of cases (n=157) entailed primary anastomosis, while the remainder underwent augmentation reconstruction (graft or flap). The mean follow-up time after urethroplasty varied from 10 to 50.5 months. The pooled stenosis resolution rate was 80% (95% CI: 74-86%). There were no significant associations between stenosis resolution rate and reconstructive technique (rho=0.20, p=0.74) or RT modality (rho=-0.31, p=0.53). Fifty-three cases developed subsequent SUI, with a pooled complication rate of 19% (95% CI: 10-31%).
Urethroplasty after RIUS is effective for 80% of cases, independent of prior RT modality or urethroplasty technique; however, 1 out of every 5 patients develops SUI post-procedure.
Urology. 2021 Feb 22 [Epub ahead of print]
Lucas Gomes Sapienza, Matthew Stephen Ning, Emanuel de Freitas Carvalho, Daniel Spratt, Vinícius Fernando Calsavara, Patrick W McLaughlin, Maria Jose Leite Gomes, Glauco Baiocchi, Eyad Abu-Isa
Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA. Electronic address: ., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil., Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA., Department of Statistics and Epidemiology, AC Camargo Cancer Center, São Paulo, SP, Brazil., Department of Radiation Oncology, Hospital Federal dos Servidores do Estado (HFSE-RJ), Rio de Janeiro, RJ, Brazil., Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.