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Female urethral reconstruction is complex, and one must carefully evaluate patients afflicted with urethral disorders. Urethral stricture and urethral loss have different etiologies. Variations of a standard approach might best address the condition of an individual patient. Long-term outcomes data are not available for contemporary techniques of female urethral reconstruction. The highest success rates have been reported with vaginal flap and buccal mucosal graft urethroplasty. Further studies focusing on newer reconstruction techniques and long-term outcomes are warranted.

BACKGROUND: Men with locally (LAPCa) or regionally advanced (RAPCa) prostate cancer are at high risk of death from their disease. Clinical guidelines support multi-modal approaches, which include radical prostatectomy (RP) followed by radiotherapy (XRT) or radiotherapy plus androgen deprivation therapy (ADT). However, limited data exists comparing these substantially different treatment approaches. Using SEER-Medicare data, we compare survival outcomes and adverse effects associated with RP+XRT vs XRT+ADT in these men. METHODS: SEER-Medicare data was queried for men with cT3-T4, N0, M0 (LAPCa) or cT3-T4, N1, M0 (RAPCa) prostate cancer. Propensity score methods were used to balance cohort characteristics between treatment arms. Survival analyses were analyzed using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: From 1992 to 2009, 13,856 men (≥65 years) were diagnosed with LAPCa or RAPCa, of which 6.1% received RP+XRT vs 23.6% who received XRT+ADT. At a median follow-up of 14.6 years, there were 2189 deaths in the cohort, of which 702 were secondary to prostate cancer. Irrespective of tumor stage and Gleason score, adjusted 10-year prostate cancer-specific survival and 10-year overall survival favored men who underwent RP+XRT when compared to XRT+ADT. However, RP+XRT vs. XRT+ADT was associated with higher rates of erectile dysfunction (28% vs. 20%, p=0.0212, respectively) and urinary incontinence (49% vs. 19%, p<0.001, respectively). CONCLUSIONS: Men with LAPCa or RAPCa treated initially with RP+XRT had a lower risk of prostate cancer-specific death and improved overall survival when compared to those men treated with XRT+ADT, but experienced higher rates of erectile dysfunction and urinary incontinence.