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Radiotherapy-Induced Urethral Strictures

  • Steven B. BrandesEmail author
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

The overall incidence of bulbomembranous urethral stricture or bladder neck contracture after radiation therapy is roughly 3–16 %. Time to stricture presentation is usually delayed (24 months) and insidious. Radiation urethral strictures typically have an unhealthy or pale appearance on cystoscopy, with varying degrees of local tissue induration or dense fibrotic scarring. Radiation-induced urethral strictures are often refractory to urethrotomy or dilation and merely palliative and require successive treatments. Management methods include intermittent self-catheterization, off-label use of an endourethral prosthesis, excision and primary urethral anastomosis urethroplasty, onlay flap and graft urethroplasty, salvage prostatectomy with anastomotic urethrovesical urethroplasty, combined abdominoperineal urethroplasty, onlay flap urethroplasty, and supravesical urinary diversion surgery. Urethroplasty seems to be feasible and reasonably successful for RT strictures in the short term, with the best results with anastomotic urethroplasty.

Keywords

Urinary Diversion Urethral Stricture Artificial Urinary Sphincter Urethral Dilation Bladder Neck Contracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Elliot SP, Meng MV, Elkin EP, McAninch JW, Duchane J, Carroll PR. Incidence of urethral stricture after primary treatment for prostate cancer: data from CaPSURE. J Urol. 2007;178:529–34.CrossRefGoogle Scholar
  2. 2.
    Sandhu AS, Zelefsky MJ. Long-term urinary toxicity after 3-dimensional conformal radiotherapy for prostate cancer in patients with prior history of transurethral resection. Int J Radiat Oncol Biol Phys. 2000;48:643–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Merrick GS, Butler WM. Risk factors for the development of prostate brachytherapy related urethral strictures. J Urol. 2006;175:1376–80.PubMedCrossRefGoogle Scholar
  4. 4.
    Wallner K, Roy J, Harrison JL. Dosimetry guidelines to minimize urethral and rectal morbidity following transperineal I-125 prostate brachytherapy. Int J Rad Oc Bio Phys. 1995. 32(2):465–71.CrossRefGoogle Scholar
  5. 5.
    Astrom L, Pedersen D. Long-term outcome of high dose rate brachytherapy in radiotherapy of localised prostate cancer. Radiother Oncol. 2005;74:157–61.PubMedCrossRefGoogle Scholar
  6. 6.
    Wallner K, Roy J, Harrison L. Dosimetry guidelines to minimize urethral and rectal morbidity following transperineal I-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys. 1995;32:465–71.PubMedCrossRefGoogle Scholar
  7. 7.
    Zelefsky MJ, Yamada Y, Cohen G, Venkatraman ES, Fung AY, Furhang E, Silvern D, Zaider M. Postimplantation dosimetric analysis of permanent transperineal prostate implantation: improved dose distributions with an intraoperative computer-optimized conformal planning technique. Int J Radiat Oncol Biol Phys. 2000;48:601–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Galalae RM, Kovács G, Schultze J, Loch T, Rzehak P, Wilhelm R, Bertermann H, Buschbeck B, Kohr P, Kimmig B. Long-term outcome after elective irradiation of the pelvic lymphatics and local dose escalation using high-dose-rate brachytherapy for locally advanced prostate cancer. Int J Radiat Oncol Biol Phys. 2002;52(1):81–90.PubMedCrossRefGoogle Scholar
  9. 9.
    Demanes DJ, Rodriguez RR. High-dose-rate intensity-modulated brachytherapy with external beam radiotherapy for prostate cancer: California endocurietherapy’s 10-year results. Int J Radiat Oncol Biol Phys. 2005;61:1306–16.PubMedCrossRefGoogle Scholar
  10. 10.
    Martinez AA, Pataki I. Phase II prospective study of the use of conformal high-dose-rate brachytherapy as monotherapy for the treatment of favorable stage prostate cancer: a feasibility report. Int J Radiat Oncol Biol Phys. 2001;49:61–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Albert M, Tempany CM, Schultz D, Chen MH, Cormack RA, Kumar S, Hurwitz MD, Beard C, Tuncali K, O’Leary M, Topulos GP, Valentine K, Lopes L, Kanan A, Kacher D, Rosato J, Kooy H, Jolesz F, Carr-Locke DL, Richie JP, D’Amico AV. Late genitourinary and gastrointestinal toxicity after magnetic resonance image-guided prostate brachytherapy with or without neoadjuvant external beam radiation therapy. Cancer. 2003;98:949–54.PubMedCrossRefGoogle Scholar
  12. 12.
    Sullivan L, et al. Urethral stricture following high dose rate brachytherapy for prostate cancer. Radiother Oncol. 2009;91(2):232–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Greskovich FJ. Complications following external beam radiation therapy for prostate cancer: an analysis of patients treated with and without staging pelvic lymphadenectomy. J Urol. 1991;146:798–802.PubMedGoogle Scholar
  14. 14.
    Seymore CH, el-Mahdi AM, Schellhammer PF. The effect of prior transurethral resection of the prostate on post radiation urethral strictures and bladder neck contractures. Int J Radiat Oncol Biol Phys. 1986;12(9):1597–600.PubMedCrossRefGoogle Scholar
  15. 15.
    Baskin LS, Constantinescu SC. Biochemical characterization and quantitation of the collagenous components of urethral stricture tissue. J Urol. 1993;150:642–7.PubMedGoogle Scholar
  16. 16.
    Cavalcanti AG, Yucel S. The distribution of neuronal and inducible nitric oxide synthase in urethral stricture formation. J Urol. 2004;171:1943–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Ragde H. Brachytherapy (seed implantation) for clinically localized prostate cancer. J Surg Oncol. 1997;64:79–81.PubMedCrossRefGoogle Scholar
  18. 18.
    Moreira Jr SG, Seigne JD, Ordorica RC, Marcet J, Pow-Sang JM, Lockhart JL. Devastating complications after brachytherapy in the treatment of prostate adenocarcinoma. BJU Int. 2004;93:31–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Steenkamp JW, et al. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol. 1997;157:98–101.PubMedCrossRefGoogle Scholar
  20. 20.
    Pansodoro V, Emiliozzi P. Internal urethrotomy in the management of anterior urethral strictures: long term follow up. J Urol. 1996;156(1):73–5.CrossRefGoogle Scholar
  21. 21.
    Zelefsky MJ, Levin EJ, Hunt M, et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;15(70):1124–9.CrossRefGoogle Scholar
  22. 22.
    Heyns CF, Steenkamp JW, et al. Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol. 1998;160(2):356–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Glass AS, McAninch JW, Zaid UB, et al. Urethroplasty after radiation therapy for prostate cancer. Urology. 2012;79(6):1402–6.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Meeks JJ, Brandes SB, Morey AF, et al. Urethroplasty for radiotherapy induced bulbomembranous strictures: a multi-institutional experience. J Urol. 2011;185(5):1761–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Urologic Surgery, Department of SurgeryWashington University School of MedicineSt LouisUSA

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