Management of radiation-induced urethral strictures

Matthias Dominikus Hofer, Chris M. Gonzalez*

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Radiation as a treatment option for prostate cancer has been chosen by many patients. One of the side effects encountered are radiation-induced urethral strictures which occur in up to 11% of patients. Radiation damage has often left the irradiated field fibrotic and with poor vascularization which make these strictures a challenging entity to treat. The mainstay of urologic management remains an urethroplasty procedure for which several approaches exist with variable optimal indication. Excision and primary anastomoses are ideal for shorter bulbar strictures that comprise the majority of radiation-induced urethral strictures. One advantage of this technique is that it does not require tissue transfers and success rates of 70-95% have consistently been reported. Substitution urethroplasty using remote graft tissue such as buccal mucosa are indicated if the length of the stricture precludes a tension-free primary anastomosis. Despite the challenge of graft survival in radiation-damaged and poorly vascularized recipient tissue, up to 83% of patients have been treated successfully although the numbers described in the literature are small. The most extensive repairs involve the use of tissue flaps, for example gracilis muscle, which may be required if the involved periurethral tissue is unable to provide sufficient vascular support for a post-operative urethral healing process. In summary, radiation-induced urethral strictures are a challenging entity. Most strictures are amenable to excision and primary anastomosis (EPA) with encouraging success rates but substitution urethroplasty may be indicated when extensive repair is needed.

Original languageEnglish (US)
Pages (from-to)66-71
Number of pages6
JournalTranslational Andrology and Urology
Volume4
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • Radiation
  • Review
  • Urethral stricture

ASJC Scopus subject areas

  • Reproductive Medicine
  • Urology

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