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.
To evaluate the etiology, timing, management, and outcomes of radiation induced urethral strictures.
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.
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.
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.
|Etiology||Number Pts||Number Incontinent by Etiology and Location|
|Brachytherapy/EBRT||19 (48%)||7 (37%)|
|EBRT||11 (28%)||4 (37%)|
|S/P RRP+ Salvage EBRT||5 (12%)||5 (100%)|
|Brachytherapy||5 (12%)||3 (60%)|
|Bulbomembranous||15 (38%)||8 (53%)|
|Trans-sphincteric||8 (20%)||6 (75%)|
|Bulbar||6 (15%)||2 (33%)|
|Membranous||8 (20%)||1 (13%)|
|Posterior urethra||3 (7%)||2 (66%)|