Endourethral brachytherapy for prevention of recurrent urethral stricture following internal urethrotomy--first clinical experiences and results.
OBJECTIVE
To evaluate the therapeutic effect of endourethral brachytherapy for prevention of recurrent urethral stricture after internal urethrotomy.


METHODS
Endourethral high-dose-rate (HDR) brachytherapy was performed in 10 male patients with recurrent urethral strictures after radical prostatectomy or transurethral resection of prostatic adenoma. Brachytherapy commenced on the day of the actual intervention and continued over 3 days; the radiotherapy dose was 4 x 3 = 12 Gy for the first 3 patients and 4 x 4 Gy = 16 Gy for the following 7 patients.


RESULTS
During follow-up (range: 8-27 months, mean: 14.8 months), 9 of 10 patients remained relapse-free, i.e., without recurrent strictures or requiring another urethrotomy. In 1 patient with a restricture after endourethral brachytherapy, a second brachytherapy course was performed; nevertheless, he experienced a further restricture 12 months after the second intervention. No radiation-induced acute toxicity occurred, but 1 patient developed incontinence after the current urethrotomy. Overall, patient satisfaction and compliance with the therapeutic procedures was high.


CONCLUSIONS
Endourethral HDR brachytherapy proved to be a safe method that can reduce urethral restricture. Further follow-up is needed to prove long-term efficacy of this treatment. Further investigations are planned to evaluate the adequate fractionation and possible late treatment sequelae.
Olschewski
Thomas
T
Department of Radiotherapy and Radiation Oncology, Alfried Krupp Krankenhaus, Essen, Germany.
Kröpfl
Darko
D
Seegenschmiedt
Michael Heinrich
MH
D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011471:Prostatic Neoplasms / Q000601:surgery; D055502:Secondary Prevention; D014525:Urethral Stricture / Q000209:etiology / Q000517:prevention & control*; D014546:Urinary Catheterization