SIU/ICUD Consultation on Urethral Strictures: Posterior Urethral Stenosis After Treatment of Prostate Cancer

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

“…Commonly cited comorbid conditions associated with higher likelihood of anastomotic stenosis are coronary artery disease, hypertension, diabetes mellitus, cigarette smoking, obesity, prior bladder outlet reduction surgery, and older age. 13,19,27,28,[33][34][35] Similar to the changes induced with radiation therapy, many of these conditions negatively affect vascular health, thereby increasing the risk of ischemia or poor tissue healing.…”

“…Anastomotic urine leak, intravesical foreign body, increased operative time and increased estimated blood loss have been cited by multiple studies as risk factors for VUAS. 6,7,13,19,27,28,[33][34][35][36][37][38][39] Given that most of these factors are caused by or increase the risk of poor anastomotic mucosal apposition, it is intuitive to assume this as an important risk factor for VUAS formation. 29 To address this concern, Srougi et al described a technique in which the bladder neck mucosa was everted to improve apposition and reduce VUAS, but an improvement in rates of VUAS with this technique was not noted.…”

Nontransecting Anastomotic Repair in Urethral Reconstruction: Surgical and Functional Outcomes

“…success rate of TAR for different types of posterior strictures [3][4][5][6] . Although comparison between series must be done with caution and is subject to bias, it appears that NTAR is non-inferior to TAR, but with the advantage of sparing the dual blood supply.…”

“…At present, anastomotic repair is recommended as preferred technique for short bulbar strictures 1,2 , pelvic fracture related posterior strictures 2,3 and recurrent non-traumatic posterior strictures [4][5][6] . For bulbar strictures, the corpus spongiosum containing the urethra is completely transected at the stricture site.…”

Total Bladder and Posterior Urethral Reconstruction: Salvage Technique for Defunctionalized Bladder with Recalcitrant Posterior Urethral Stenosis

“…1 Posterior urethral stenosis may be located at the bladder neck, vesicourethral anastomosis, or the prostatic, membranous and bulbomembranous urethra. Often strictures or stenoses span multiple areas and may be associated with obliteration of the urethral lumen.…”