ICUD on Urethral StricturesSIU/ICUD Consultation on Urethral Strictures: Posterior Urethral Stenosis After Treatment of Prostate Cancer
Section snippets
Material and Methods
The committee assessed and reviewed the epidemiology, evaluation, and management of PUS after localized treatment of prostate cancer. Studies from the past 15 years from peer-reviewed journals, abstracts from scientific meetings, and published data searches manually and electronically formed the basis of the present review. The search terms used included “prostate cancer,” “radical prostatectomy,” “radiation, brachytherapy,” “cryotherapy,” and “high-intensity focused ultrasound (HIFU).”
As a
Radical Prostatectomy
PUS after RP manifests as a narrowing of the anastomosis between the bladder neck and the membranous urethra, commonly termed “bladder neck contracture” (BNC), which occurs in 1.4%-29% of patients after RP (Table 1).4, 5, 6, 7, 8 The number of RPs performed in the United States exceeded 80,000 in 2001 and has continued to remain constant despite concerns about the public health benefit of prostate-specific antigen screening. Using conservative estimates from published studies, it has been
Evaluation and Preoperative Management
Men who develop PUS after treatment of prostate cancer can present with lower urinary tract symptoms (LUTS), both storage and voiding. The usual timing of the onset of the stenosis is dependent on the type of treatment administered. With RT, both EBRT and BT, it usually occurs within a few years. After RP (with or without EBRT), TURP, or interventions such as HIFU and cryotherapy that result in tissue sloughing, the symptoms of obstructed voiding can occur immediately after catheter removal or,
Treatment
Strictures related to prostate cancer therapy result from a number of interacting mechanisms, including anatomic tissue loss from surgery, postoperative fibrosis, ionizing radiation, and electrical injury. Thus, treatment must take into consideration the surrounding anatomic characteristics, capacity for healing, and ability to support transfer of adjacent or distant donor tissue sites. The continence status of the patient and the relationship of the stricture to the external sphincter further
Conclusion
The risk factors for the development of VUAS identified in case series and large prospective RP studies can be divided into preoperative, intraoperative, and postoperative categories and include excessive blood loss, type of bladder neck dissection, postoperative urinary leakage, adjuvant RT, previous TURP, smoking, older age, obesity, and surgeon experience (LE 2-3). Other risk factors include open vs minimally invasive surgery (LE 2-3) and acute postoperative retention treated with suprapubic
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Financial Disclosure: S.H. receives royalties from Cook Medical. The remaining authors declare that they have no relevant financial interests.