To analyze the location and management of urethral stricture/stenosis in patients treated with HIFU of the prostate as well as to describe patient reported satisfaction in these men.
Patients with a history of HIFU requesting consultation for stricture were identified from 2010-2020.
Demographic and prior treatment data were recorded. Patients who presented for evaluation underwent retrograde cystoscopy, retrograde urethrogram, voiding cystourethrogram, and antegrade cystoscopy through a suprapubic tract. Patients who only had virtual consultation and did not present for in-person evaluation, were followed longitudinally to assess long-term outcomes and quality of life.
Over the 10-year study period, 17 patients were identified with a mean age of 65.8 years. Prior to initial consultation, a total of 88% of patients had at least one failed surgical intervention at a mean of 45 months post-HIFU. The majority of patients (94%) had strictures that included but were not necessarily limited to the prostatic urethra. Patients underwent various treatments post-evaluation, favoring endoscopic therapy (38%) and proximal diversion (20%) at a mean follow-up of 68.2 ± 7.5 months. Only 38% reported satisfaction with urinary symptoms.
Urethral narrowing post-HIFU appears to overwhelmingly involve the prostatic urethra. Patients usually have a significant treatment burden over a prolonged period and are often managed with repeated endoscopic treatment, extirpative prostatic surgery, or urinary diversion as they have obstruction that is not amendable to urethral reconstruction. Most patients with HIFU strictures experience a diminished QOL due to persistent urinary symptoms.
Urology. 2022 Jun 06 [Epub ahead of print]
David W Barham, John Barnard, Joel Gelman
Department of Urology, University of California, Irvine. Electronic address: ., Department of Urology, West Virginia University. Electronic address: ., Department of Urology, University of California, Irvine. Electronic address: .