Management of urethral stricture due to prostate cancer and colorectal cancer radiotherapy: a systematic review

Abstract

Background: Prostate and colorectal cancer are the second and third most common cancer in male. Radiotherapy is performed as treatment option for both cancers. Thus, lead to the increasing case of radiotherapy-induced urethral stricture. Recurrent stricture post-correction commonly occurs.Methods: Six relevant English literatures were found throughout online database published between 2011-2017. PICO is used to identify components of clinical evidence to create systematic review. Subjects include 222 radiotherapy-induced urethral stricture patients due to prostate and colorectal cancer who undergone various treatment modality options.Results: Radiotherapy modality performed in sample population were External Beam Radiotherapy (EBRT) (44.1%), Brachytherapy (BT) (31.5%), EBRT/BT (16.2%), Adjuvant EBRT (6.8%), salvage EBRT (0.9%), and proton beam (0.5%). Strictures were found in bulbomembranous-urethra (64.4%), bulbar-urethra (17.1%), posterior-urethra (10.8%), membranous-urethra (5.4%), vesico-urethra (1.4%), and pan-urethra (0.9%). Known mean onset for urethral-induced radiotherapy is 5.6 years. Treatment options include anastomosis urethroplasty (61.3%), Buccal Mucosa Graft Urethroplasty (23.4%), urolume stent (10.8%), penile island flap onlay (2.2%), Genital fasciocutaneous skin flap (1.4%), and perineal flap urethroplasty (0.9%). Known mean onset for urethral stricture recurrence is 10.8 months.Conclusion: Urethral strictures commonly occur after radiation therapy for prostate and colorectal cancer. Urethroplasty is the preferable treatment option. The recurrence onset for urethral stricture post urethroplasty is shorter than urethral strictures in general.