[Urethral stricture after radiation therapy]

Area of Science:

• Urology
• Oncology
• Radiotherapy

Background:

• Radiation-induced urethral stricture is a frequent complication of prostate cancer treatment.
• Stricture incidence varies with radiotherapy type: lowest with external beam radiation therapy (EBRT), higher with brachytherapy, and highest with combined EBRT and brachytherapy.
• Strictures predominantly affect the bulbomembranous urethra.

Purpose of the Study:

• To review diagnostic work-up for radiation-induced urethral strictures.
• To compare management options, focusing on endoscopic procedures versus urethroplasty.
• To evaluate the success rates and complication profiles of different urethroplasty techniques.

Main Methods:

• Review of diagnostic modalities including ultrasound, uroflowmetry, urethroscopy, retrograde urethrogram, and voiding cystourethrography.
• Comparison of endoscopic management (dilatation, internal urethrotomy) with surgical reconstruction (urethroplasty).
• Analysis of reported success rates and incontinence rates for primary end-to-end anastomosis (EPA) and buccal mucosa graft urethroplasty (BMGU).

Main Results:

• Endoscopic management of short strictures has a high recurrence risk.
• Primary end-to-end anastomosis (EPA) shows 70-95% success rates with 7-40% incontinence.
• Buccal mucosa graft urethroplasty (BMGU) has 71-78% success rates with 10.5-44% postoperative incontinence, often treatable with artificial urinary sphincters.

Conclusions:

• EPA is preferred for short urethral strictures.
• BMGU is indicated for longer, more complex strictures.
• Patient counseling regarding stricture characteristics and potential postoperative incontinence is crucial.