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Management of Urethral Strictures Following Radiation Therapy
Alex J. Vanni, M.D., Spencer Kozinn, M.D., Leonard N. Zinman, M.D., Jill C. Buckley, M.D..
Lahey Clinic, Burlington, MA, USA.

Background:
To evaluate the etiology, timing, management, and outcomes of radiation induced urethral strictures.
Methods:
A retrospective review of consecutive patients with radiation induced urethral strictures between 2003-2009 was performed. Inclusion criteria included male patients with urethral strictures and a history of pelvic radiation therapy. Exclusion criteria included patients with a history of urethral or penile cancer, rectourethral fistula, or presentation with a bladder neck contracture. Patient demographics, operative, and postoperative data were reviewed.
Results:
40 patients presented with obstructing urethral strictures at a median age of 68 years (range 28-84), with a median follow-up of 12 months (range 0-120). Mean time from radiation to diagnosis of stricture was 62 months (range 0-240). Stricture etiology and location are found in the table. 95% of patients had at least 1 urethrotomy or dilation, while 83% required 2 or more procedures. 23% of patients required transurethral resection of prostatic necrosis. 33% of patients were managed with a urethral dilation schedule. Urethral reconstruction was performed in 23% of patients, with an additional 5% of patients expecting urethral reconstruction. 33% of patients undergoing urethral reconstruction have required an additional urethrotomy for stricture stabilization. 13% of all patients either have or are expecting urinary diversion due to radiation induced complications. 13% of all patients have an indwelling foley or suprapubic tube for urinary retention. Urinary incontinence was noted in 48% of all patients at last follow-up. 3/5 patients with artificial urinary sphincters (AUS) placed were removed for erosion. 2 patients had a total of 4 additional AUS placed, all of which were removed for erosion.
Conclusions:
Radiation induced urethral strictures represent the most challenging group of urethral strictures. Definitive treatment has not been established, and a majority of patients will require several surgical procedures. Careful patient selection is essential before AUS placement.

EtiologyNumber PtsNumber Incontinent by Etiology and Location
Brachytherapy/EBRT19 (48%)7 (37%)
EBRT11 (28%)4 (37%)
S/P RRP+ Salvage EBRT5 (12%)5 (100%)
Brachytherapy5 (12%)3 (60%)
Stricture Location
Bulbomembranous15 (38%)8 (53%)
Trans-sphincteric8 (20%)6 (75%)
Bulbar6 (15%)2 (33%)
Membranous8 (20%)1 (13%)
Posterior urethra3 (7%)2 (66%)

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