[Endourethral brachytherapy for the prevention of recurrent strictures following internal urethrotomy].
METHODS
Between November 2000 and December 2002 endoscopic incision or transurethral scar resection was followed by endourethral brachytherapy (BT) which was performed in patients with recurrent bulbar strictures ( n=9), bladder neck stenosis after transurethral prostatectomy (TUR-P) ( n=3), anastomotic stricture after radical prostatectomy ( n=2) or penile urethral stricture ( n=1). High dose rate (HDR) iridium-192 BT started on the day of the endoscopic incision or resection and continued for the following 3 days. The BT fractionation scheme was 4x3 Gy in the first three patients (until first relapse) and 4x4 Gy in all following patients. The dose was calculated at 3 mm tissue depth using 3-dimensional CT-planning. As of February 2004, the median follow-up of all patients reached 22 months.


RESULTS
Seven of 15 patients (46%) are recurrence free. In two patients (13.3%), recurrent strictures developed 12 month later, outside of the region of initial treatment. In six patients (40%) the treatment was considered to be unsuccessful as recurrent strictures were found between 2 and 12 months after the initial or second course of treatment.


CONCLUSIONS
Endourethral brachytherapy after endoscopic incision or resection is a promising treatment for the prevention of recurrent strictures of the urethra, bladder neck or vesicourethral anastomosis. The initial results have been very good, but with longer follow-up recurrence occurred in the irradiated area in 40% of patients. Prospective randomized studies in patients with a strictly defined type of recurrent stricture, or even after the first internal urethrotomy, should be done in the future.
Kröpfl
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Klinik für Urologie, Kinderurologie und urologische Onkologie, Ev. Huyssens-Stift gGmbH, Essen. a.bartelds@kliniken-essen-mitte.de
Olschewski
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Seegenschmiedt
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D004724:Endoscopy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D016896:Treatment Outcome; D014521:Urethra / Q000528:radiation effects* / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000517:prevention & control* / Q000532:radiotherapy*; D013519:Urogenital Surgical Procedures / Q000009:adverse effects*