Urethral Stricture and Urethroplasty in the Pelvic Irradiated Patient

Summary

The overall incidence of bulbo-membranous urethral stricture or bladder neck contracture after radiation therapy is roughly 3–16%. Time to stricture presentation is usually delayed (24 months) and insidious. Radiation urethral strictures typically have an unhealthy or pale appearance on cystoscopy, with varying degrees of local tissue induration or dense fibrotic scarring. Radiation induced urethral strictures are often refractory to urethrotomy or dilation, and more likely complex management dilemmas. Management methods include urethrotomy and intermittent self-catheterization, off-label use of an endourethral prosthesis, excision and primary urethral anastomosis urethroplasty, salvage prostatectomy with anastomotic urethrovesical urethroplasty, combined abdominal-perineal urethroplasty, onlay flap urethroplasty, and supravesical urinary diversion surgery. Grafts should generally be avoided in the radiated field unless buttressed by a muscle flap.