Management of Bladder Neck Stenosis Secondary to Radical Prostatectomy or Radiation Treatment

Bladder neck stenosis (BNS) and posterior urethral stenosis (PUS) are uncommon but problematic complications of treatment for localized prostate cancer. Overall, BNS is less common following minimally invasive radical prostatectomy than open. Patients who develop PUS following radiation therapy (RT) (especially salvage RT) pose a greater challenge and tend to present longer after treatment. Regardless of etiology, treatment begins conservatively with endoscopic management but quickly progresses to more aggressive intervention if refractory. Urethral stents have been used with acceptable results. In patients who fail conservative therapy after radical prostatectomy (RP), open reconstruction should be considered. After RT, patients may ultimately benefit from urinary diversion or salvage prostatectomy. After treatment, many patients will require implantation of artificial urinary sphincter (AUS) for management of incontinence. Patient counseling prior to treatment selection for initial prostate cancer therapy is important; complications, future management, and potential for return to normal quality of life vary widely.