Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease

Matthias D. Hofer, Lee C. Zhao, Allen F. Morey, J. Francis Scott, Andrew J. Chang, Steven B. Brandes, Chris M. Gonzalez

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Abstract

Purpose We recently demonstrated that radiotherapy induced urethral strictures can be successfully managed with urethroplasty. We increased size and followup in our multi-institutional cohort, and evaluated excision and primary anastomosis as treatment for radiotherapy induced urethral strictures. Materials and Methods A retrospective review was performed of 72 patients from 3 academic institutions treated for radiotherapy induced bulbomembranous strictures. Outcome parameters of successful repair included recurrence, incontinence and erectile dysfunction. Results Among the 72 men treated for radiotherapy induced strictures 66 (91.7%) underwent excision and primary anastomosis. Mean followup was 3.5 years (median 3.1, range 0.8 to 11.2). Prostate cancer was the most common reason for radiotherapy (in 64 of 66, 96.9%). External beam radiotherapy and brachytherapy were performed in 28 of 66 men (42.4%) each, and a combination of both was performed in 9 (13.6%). Mean time from radiation to excision and primary anastomosis was 6.4 years (range 1 to 20) and mean stricture length was 2.3 cm (range 1 to 6). Successful reconstruction was achieved in 46 men (69.7%). Mean time to recurrence was 10.2 months (range 1 to 64) with new onset of incontinence observed in 12 men (18.5%). This was associated with stricture length greater than 2 cm (p = 0.013) and treatment center (p <0.001). The rate of erectile dysfunction remained stable (preoperative 45.6%, postoperative 50.9%, p = 0.71). Radiotherapy type did not affect stricture length (p = 0.41), recurrence risk (p = 0.91), postoperative incontinence (p = 0.88) or erectile dysfunction (p = 0.53). Conclusions Radiotherapy induced bulbomembranous urethral strictures can be successfully managed with excision and primary anastomosis. Substitution urethroplasty with graft or flap is needed infrequently. Patients should be counseled on the potential risks of urinary incontinence and erectile dysfunction.

Original languageEnglish (US)
Pages (from-to)1307-1312
Number of pages6
JournalJournal of Urology
Volume191
Issue number5
DOIs
StatePublished - 2014

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Urethral Diseases
Urethral Stricture
Radiotherapy
Erectile Dysfunction
Pathologic Constriction
Recurrence
Brachytherapy
Urinary Incontinence
Prostatic Neoplasms
Radiation
Transplants

Keywords

  • anastomosis
  • radiotherapy
  • surgical
  • urethral stricture

ASJC Scopus subject areas

  • Urology

Cite this

Hofer, M. D., Zhao, L. C., Morey, A. F., Scott, J. F., Chang, A. J., Brandes, S. B., & Gonzalez, C. M. (2014). Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease. Journal of Urology, 191(5), 1307-1312. https://doi.org/10.1016/j.juro.2013.10.147

Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease. / Hofer, Matthias D.; Zhao, Lee C.; Morey, Allen F.; Scott, J. Francis; Chang, Andrew J.; Brandes, Steven B.; Gonzalez, Chris M.

In: Journal of Urology, Vol. 191, No. 5, 2014, p. 1307-1312.

Research output: Contribution to journalArticle

Hofer, MD, Zhao, LC, Morey, AF, Scott, JF, Chang, AJ, Brandes, SB & Gonzalez, CM 2014, 'Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease', Journal of Urology, vol. 191, no. 5, pp. 1307-1312. https://doi.org/10.1016/j.juro.2013.10.147
Hofer, Matthias D. ; Zhao, Lee C. ; Morey, Allen F. ; Scott, J. Francis ; Chang, Andrew J. ; Brandes, Steven B. ; Gonzalez, Chris M. / Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease. In: Journal of Urology. 2014 ; Vol. 191, No. 5. pp. 1307-1312.
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abstract = "Purpose We recently demonstrated that radiotherapy induced urethral strictures can be successfully managed with urethroplasty. We increased size and followup in our multi-institutional cohort, and evaluated excision and primary anastomosis as treatment for radiotherapy induced urethral strictures. Materials and Methods A retrospective review was performed of 72 patients from 3 academic institutions treated for radiotherapy induced bulbomembranous strictures. Outcome parameters of successful repair included recurrence, incontinence and erectile dysfunction. Results Among the 72 men treated for radiotherapy induced strictures 66 (91.7{\%}) underwent excision and primary anastomosis. Mean followup was 3.5 years (median 3.1, range 0.8 to 11.2). Prostate cancer was the most common reason for radiotherapy (in 64 of 66, 96.9{\%}). External beam radiotherapy and brachytherapy were performed in 28 of 66 men (42.4{\%}) each, and a combination of both was performed in 9 (13.6{\%}). Mean time from radiation to excision and primary anastomosis was 6.4 years (range 1 to 20) and mean stricture length was 2.3 cm (range 1 to 6). Successful reconstruction was achieved in 46 men (69.7{\%}). Mean time to recurrence was 10.2 months (range 1 to 64) with new onset of incontinence observed in 12 men (18.5{\%}). This was associated with stricture length greater than 2 cm (p = 0.013) and treatment center (p <0.001). The rate of erectile dysfunction remained stable (preoperative 45.6{\%}, postoperative 50.9{\%}, p = 0.71). Radiotherapy type did not affect stricture length (p = 0.41), recurrence risk (p = 0.91), postoperative incontinence (p = 0.88) or erectile dysfunction (p = 0.53). Conclusions Radiotherapy induced bulbomembranous urethral strictures can be successfully managed with excision and primary anastomosis. Substitution urethroplasty with graft or flap is needed infrequently. Patients should be counseled on the potential risks of urinary incontinence and erectile dysfunction.",
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AU - Chang, Andrew J.

AU - Brandes, Steven B.

AU - Gonzalez, Chris M.

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N2 - Purpose We recently demonstrated that radiotherapy induced urethral strictures can be successfully managed with urethroplasty. We increased size and followup in our multi-institutional cohort, and evaluated excision and primary anastomosis as treatment for radiotherapy induced urethral strictures. Materials and Methods A retrospective review was performed of 72 patients from 3 academic institutions treated for radiotherapy induced bulbomembranous strictures. Outcome parameters of successful repair included recurrence, incontinence and erectile dysfunction. Results Among the 72 men treated for radiotherapy induced strictures 66 (91.7%) underwent excision and primary anastomosis. Mean followup was 3.5 years (median 3.1, range 0.8 to 11.2). Prostate cancer was the most common reason for radiotherapy (in 64 of 66, 96.9%). External beam radiotherapy and brachytherapy were performed in 28 of 66 men (42.4%) each, and a combination of both was performed in 9 (13.6%). Mean time from radiation to excision and primary anastomosis was 6.4 years (range 1 to 20) and mean stricture length was 2.3 cm (range 1 to 6). Successful reconstruction was achieved in 46 men (69.7%). Mean time to recurrence was 10.2 months (range 1 to 64) with new onset of incontinence observed in 12 men (18.5%). This was associated with stricture length greater than 2 cm (p = 0.013) and treatment center (p <0.001). The rate of erectile dysfunction remained stable (preoperative 45.6%, postoperative 50.9%, p = 0.71). Radiotherapy type did not affect stricture length (p = 0.41), recurrence risk (p = 0.91), postoperative incontinence (p = 0.88) or erectile dysfunction (p = 0.53). Conclusions Radiotherapy induced bulbomembranous urethral strictures can be successfully managed with excision and primary anastomosis. Substitution urethroplasty with graft or flap is needed infrequently. Patients should be counseled on the potential risks of urinary incontinence and erectile dysfunction.

AB - Purpose We recently demonstrated that radiotherapy induced urethral strictures can be successfully managed with urethroplasty. We increased size and followup in our multi-institutional cohort, and evaluated excision and primary anastomosis as treatment for radiotherapy induced urethral strictures. Materials and Methods A retrospective review was performed of 72 patients from 3 academic institutions treated for radiotherapy induced bulbomembranous strictures. Outcome parameters of successful repair included recurrence, incontinence and erectile dysfunction. Results Among the 72 men treated for radiotherapy induced strictures 66 (91.7%) underwent excision and primary anastomosis. Mean followup was 3.5 years (median 3.1, range 0.8 to 11.2). Prostate cancer was the most common reason for radiotherapy (in 64 of 66, 96.9%). External beam radiotherapy and brachytherapy were performed in 28 of 66 men (42.4%) each, and a combination of both was performed in 9 (13.6%). Mean time from radiation to excision and primary anastomosis was 6.4 years (range 1 to 20) and mean stricture length was 2.3 cm (range 1 to 6). Successful reconstruction was achieved in 46 men (69.7%). Mean time to recurrence was 10.2 months (range 1 to 64) with new onset of incontinence observed in 12 men (18.5%). This was associated with stricture length greater than 2 cm (p = 0.013) and treatment center (p <0.001). The rate of erectile dysfunction remained stable (preoperative 45.6%, postoperative 50.9%, p = 0.71). Radiotherapy type did not affect stricture length (p = 0.41), recurrence risk (p = 0.91), postoperative incontinence (p = 0.88) or erectile dysfunction (p = 0.53). Conclusions Radiotherapy induced bulbomembranous urethral strictures can be successfully managed with excision and primary anastomosis. Substitution urethroplasty with graft or flap is needed infrequently. Patients should be counseled on the potential risks of urinary incontinence and erectile dysfunction.

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