BERKELEY, CA (UroToday.com) - Pelvic radiation is a frequently used, effective treatment for localized prostate cancer. Radiation-induced urethral stricture is an important long-term consequence, especially in the setting of a multi-modality treatment approach.
Due to the rising incidence of prostate cancer, there will likely be an increase in the number of men with this late toxicity. Few publications describe clinical outcomes of urethroplasty for radiation-induced stricture disease, which can pose unique management challenges. We describe a retrospective, single surgeon experience of urethroplasty for radiation-induced urethral stricture disease. We reviewed clinical factors including radiation type and patient comorbidities as well as stricture factors such as prior stricture treatments, stricture location, size and repair type. We hypothesize that a variety of techniques, including anastomotic and buccal graft repair could be utilized with acceptable outcomes in this unique patient population.
| We provide evidence from a relatively large cohort, to support the safety and durability of a variety of urethroplasty repairs for patients with prostate cancer who develop urethral stricture after pelvic radiation. |
Of the 29 men treated in this cohort, a 90% success rate was achieved (median follow-up 10 months, range 12-83 months). Prior prostate cancer therapies included external beam radiation (EBRT) in 38%, radical prostatectomy (RP) with EBRT in 24%, EBRT/brachytherapy (BT) in 24% and BT alone in 14% of the cohort. The mean time from radiation exposure to stricture development was 7 ± 3.8 years. Anastomotic urethroplasty was the most common repair performed (76%), followed by buccal graft (17%) and perineal flap repair (7%). In those who underwent RP/ EBRT, a slightly lower success rate was found (88% vs. 91%) but rates did not statistically vary when cohort was stratified by radiation type. The overall complication rate was very low and included new urge incontinence (7%) and superficial wound infection (3%).
We provide evidence from a relatively large cohort, to support the safety and durability of a variety of urethroplasty repairs for patients with prostate cancer who develop urethral stricture after pelvic radiation. Future study of quality of life measures within this population, such as erectile dysfunction and urinary incontinence, is warranted.
Written by:
Allison S. Glass, MD; Jack W. McAninch, MD; James McGeady, MD; and Benjamin N. Breyer, MD, MAS as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, University of California San Francisco, San Francisco, California
Urethroplasty after radiation therapy for prostate cancer - Abstract
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