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Long-term outcomes of anastomotic urethroplasty for radiation-induced strictures

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Abstract

Purpose

To present our experience with excision and primary anastomosis (EPA) of radiation-induced urethral strictures (RUS) in men, including risk factors for stricture recurrence and long-term recurrence rates.

Methods

A retrospective review was performed of patients who underwent EPA of RUS between 2007 and 2018 at a single tertiary referral center. Demographic information, stricture location and length, complications, and stricture recurrence were analyzed. Univariate and multivariate Cox regression analyses were performed to identify variables impacting recurrence.

Results

EPA was performed in 116 patients with RUS. The majority of patients (86.2%, 100/116) underwent at least one prior urologic intervention. Mean stricture length was 2.3 cm. Stricture recurrence occurred in 19.0% (22/116) at a mean of 8.6 months. For patients with at least 1 year of postoperative follow-up (mean 30.7 months), stricture recurrence significantly increased to 36.6% (15/41; p = 0.03). On univariate and multivariate analyses, postoperative complications were associated with stricture recurrence (p < 0.001).

Conclusion

EPA remains a viable option for men with RUS. Nearly two-thirds of RUS patients remain recurrence-free with long-term follow-up following EPA.

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References

  1. Awad MA et al (2018) Prostate cancer radiation and urethral strictures: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 21(2):168–174

    Article  Google Scholar 

  2. Elliott, S.P., et al., Incidence of urethral stricture after primary treatment for prostate cancer: data From CaPSURE. J Urol, 2007. 178(2):p. 529–34 (discussion 534).

  3. Mohammed N et al (2012) Comparison of acute and late toxicities for three modern high-dose radiation treatment techniques for localized prostate cancer. Int J Radiat Oncol Biol Phys 82(1):204–212

    Article  Google Scholar 

  4. Matta R et al (2019) Pelvic complications after prostate cancer radiation therapy and their management: an International collaborative narrative review. Eur Urol 75(3):464–476

    Article  Google Scholar 

  5. Rourke K, Kinnaird A, Zorn J (2016) Observations and outcomes of urethroplasty for bulbomembranous stenosis after radiation therapy for prostate cancer. World J Urol 34(3):377–382

    Article  CAS  Google Scholar 

  6. Herschorn S et al (2014) SIU/ICUD consultation on urethral strictures: posterior urethral stenosis after treatment of prostate cancer. Urology 83(3 Suppl):S59–70

    Article  Google Scholar 

  7. Chung PH et al (2018) Incidence of stress urinary incontinence after posterior urethroplasty for radiation-induced urethral strictures. Urology 114:188–192

    Article  Google Scholar 

  8. Brant WO et al (2014) Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology 84(4):934–938

    Article  Google Scholar 

  9. Moser DC et al (2018) Impact of radiation and transcorporeal artificial sphincter placement in patients with prior urethral cuff erosion: results from a retrospective multicenter analysis. J Urol 200(6):1338–1343

    Article  Google Scholar 

  10. Osterberg EC et al (2017) Radiation-induced complex anterior urinary fistulation for prostate cancer: a retrospective multicenter study from the Trauma and Urologic Reconstruction Network of Surgeons (TURNS). World J Urol 35(7):1037–1043

    Article  Google Scholar 

  11. Fuchs JS et al (2017) Improving outcomes of bulbomembranous urethroplasty for radiation-induced urethral strictures in post-Urolume era. Urology 99:240–245

    Article  Google Scholar 

  12. Viers BR et al (2018) Delayed reconstruction of bulbar urethral strictures is associated with multiple interventions, longer strictures and more complex repairs. J Urol 199(2):515–521

    Article  Google Scholar 

  13. Browne BM, Vanni AJ (2017) Management of urethral stricture and bladder neck contracture following primary and salvage treatment of prostate cancer. Curr Urol Rep 18(10):76

    Article  Google Scholar 

  14. Ahyai SA et al (2015) Outcomes of ventral onlay buccal mucosa graft urethroplasty in patients after radiotherapy. J Urol 194(2):441–446

    Article  Google Scholar 

  15. Brown ET et al (2017) Direct visual internal urethrotomy for isolated, post-urethroplasty strictures: a retrospective analysis. Ther Adv Urol 9(2):39–44

    Article  Google Scholar 

  16. Sullivan L et al (2009) Urethral stricture following high dose rate brachytherapy for prostate cancer. Radiother Oncol 91(2):232–236

    Article  Google Scholar 

  17. Santucci R, Eisenberg L (2010) Urethrotomy has a much lower success rate than previously reported. J Urol 183(5):1859–1862

    Article  Google Scholar 

  18. Lubahn JD et al (2014) Poor quality of life in patients with urethral stricture treated with intermittent self-dilation. J Urol 191(1):143–147

    Article  Google Scholar 

  19. Fuchs JS et al (2017) Role of chronic suprapubic tube in the management of radiation induced urethral strictures. Urol Pract 4(6):479–485

    Article  Google Scholar 

  20. Meeks JJ et al (2011) Urethroplasty for radiotherapy induced bulbomembranous strictures: a multi-institutional experience. J Urol 185(5):1761–1765

    Article  Google Scholar 

  21. Palmer DA et al (2015) Urethroplasty for high risk, long segment urethral strictures with ventral buccal mucosa graft and gracilis muscle flap. J Urol 193(3):902–905

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, UT Southwestern Medical Center, 2001 Inwood Rd., Dallas, TX, 75390-9110, USA

    Christopher G. Keith, Michael T. Davenport, Mehraban Kavoussi, Yooni A. Yi, Rachel L. Bergeson & Allen F. Morey

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  1. Christopher G. Keith
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  2. Michael T. Davenport
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  3. Mehraban Kavoussi
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  4. Yooni A. Yi
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  5. Rachel L. Bergeson
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  6. Allen F. Morey
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Correspondence to Allen F. Morey.

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Keith, C.G., Davenport, M.T., Kavoussi, M. et al. Long-term outcomes of anastomotic urethroplasty for radiation-induced strictures. World J Urol 38, 3055–3060 (2020). https://doi.org/10.1007/s00345-019-03028-7

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  • DOI: https://doi.org/10.1007/s00345-019-03028-7

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