Observations and outcomes of urethroplasty for bulbomembranous stenosis after radiation therapy for prostate cancer

Rourke, Keith; Kinnaird, Adam; Zorn, Jeff

doi:10.1007/s00345-015-1608-2

Cited by 43 publications

(35 citation statements)

References 27 publications

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“…Additionally, urgency represents another bothering UAE following urethroplasty for radiation-induced strictures [6,29]. Roughly one in five patients reported urgency issues in the current series.…”

Section: Discussionmentioning

confidence: 66%

Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM)

et al. 2020

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Objectives To evaluate objective treatment success and subjective patient-reported outcomes in patients with radiationinduced urethral strictures undergoing single-stage urethroplasty. Patients and methods Monocentric study of patients who underwent single-stage ventral onlay buccal mucosal graft urethroplasty for a radiation-induced stricture between January 2009 and December 2016. Patients were characterized by descriptive analyses. Kaplan-Meier estimates were employed to plot recurrence-free survival. Recurrence was defined as any subsequent urethral instrumentation (dilation, urethrotomy, urethroplasty). Patient-reported functional outcomes were evaluated using the validated German extension of the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM). Results Overall, 47 patients were available for final analyses. Median age was 70 (IQR 65-74). Except for two, all patients had undergone pelvic radiation therapy for prostate cancer. Predominant modality was external beam radiation therapy in 70% of patients. Stricture recurrence rate was 33% at a median follow-up of 44 months (IQR 28-68). In 37 patients with available USS PROM data, mean six-item LUTS score was 7.2 (SD 4.3). Mean ICIQ sum score was 9.8 (SD 5.4). Overall, 53% of patients reported daily leaking and of all, 26% patients underwent subsequent artificial urinary sphincter implantation. Mean IIEF-EF score was 4.4 (SD 7.1), indicating severe erectile dysfunction. In 38 patients with data regarding the generic health status and treatment satisfaction, mean EQ-5D index score and EQ VAS score was 0.91 (SD 0.15) and 65 (SD 21), respectively. Overall, 71% of patients were satisfied with the outcome. Conclusion The success rate and functional outcome after BMGU for radiation-induced strictures were reasonable. However, compared to existing long-term data on non-irradiated patients, the outcome is impaired and patients should be counseled accordingly.Keyword Lower urinary tract symptoms · Patient satisfaction · Quality of life · Radiotherapy · Urinary incontinence Malte W. Vetterlein and Luis A. Kluth contributed equally.

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Section: Discussionmentioning

confidence: 66%

Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM)

et al. 2020

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“…that lichen sclerosus was responsible for long, complex, multi‐focal strictures in the penile urethra, often requiring multiple interventions. External and iatrogenic trauma was the most important cause of posterior urethral pathology, although this population was much smaller in the present study than that seen in developing countries , or in countries where aggressive treatment for prostate cancer is practised . Nevertheless, this subgroup generated a large number of re‐operations because of the associated complexity.…”

Section: Discussionmentioning

confidence: 67%

Analysis of a 7‐year national online audit of the management of open reconstructive urethral surgery in men

2019

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ObjectiveTo conduct an audit of the management of urethral pathology in men presenting for reconstructive urethral surgery in the UK. MethodsBetween 1 June 2010 and 31 May 2017, data on men presenting with urethral pathologies requiring reconstruction were entered onto a secure online data platform. Surgeonentered information was collected in 95 fields regarding the stricture aetiology, prior management, mode of presentation, type of surgery and outcomes, with a potential 283 variable responses in the 95 fields. Data were analysed to compare UK practice with that reported in the contemporary literature and with guidelines. ResultsData on 4809 men were entered by 39 centres and 50 surgeons. Field completeness was 70.7%, 74.3% and 53.7% for preoperative, operative and follow-up data, respectively. Referral for stricture reconstruction frequently followed two prior endoscopic procedures and the stricture was not always assessed anatomically before surgery. Urinary retention was a common symptom in men awaiting reconstruction. Short unifocal strictures of the anterior urethra were the commonest reason for referral, whilst lichen sclerosus and hypospadias generated a significant volume of revisional stricture surgery. Lower numbers of very complex interventions are required for the management of posterior urethral pathology. Although precise criteria for determining success are not clear, management of urethral reconstruction in the UK was found to have a low risk of Clavien-Dindo grade 3 or higher complications, and was associated with outcomes similar to those reported in contemporary series except in the management of posterior urethral fistulae. ConclusionsOnline databases can provide volume data on the management of reconstructive urethral surgery across a multiplicity of centres in one country. They can also indicate compliance with accepted standards of, and expected outcomes from, this tertiary practice.

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“…The results are not directly comparable due to differences in the definition of success and recurrence, inclusion criteria, follow-up time, surgeon experience and preference. EPA performed in 183 patients had a 70–97% success rate within 3–4 years (70,72,75,76). BMG with or without gracilis muscle flap was done in 70 patients and had a success rate of 71–80% within 2–4 years (70,73,74,76).…”

Section: Managementmentioning

confidence: 99%

“…EPA performed in 183 patients had a 70–97% success rate within 3–4 years (70,72,75,76). BMG with or without gracilis muscle flap was done in 70 patients and had a success rate of 71–80% within 2–4 years (70,73,74,76). Flap urethroplasty was performed in 10 patients and had a success rate that varied between 50–100% within 2–4 years (70,71,76).…”

Section: Managementmentioning

confidence: 99%

“…BMG with or without gracilis muscle flap was done in 70 patients and had a success rate of 71–80% within 2–4 years (70,73,74,76). Flap urethroplasty was performed in 10 patients and had a success rate that varied between 50–100% within 2–4 years (70,71,76). Patient should be counseled that new onset urinary incontinence is seen in 5–35% after surgery and may require further intervention.…”

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

Nicholson

Al-Hakeem

Maldonado

et al. 2017

Transl. Androl. Urol.

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The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet.

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Observations and outcomes of urethroplasty for bulbomembranous stenosis after radiation therapy for prostate cancer

Cited by 43 publications

References 27 publications

Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM)

Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM)

Analysis of a 7‐year national online audit of the management of open reconstructive urethral surgery in men

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

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