title: Management of severe urethral complications of prostate cancer therapy.
abstract: OBJECTIVE
  We present our management of urethral stenosis and rectourinary fistula resulting from prostate cancer therapy. We concentrated on cases refractory to minimally invasive treatment, such as dilation, urethrotomy, and urinary and/or fecal diversion.
  
  
  METHODS
  In our prospectively collected urethral reconstruction database we identified patients who underwent reconstruction of urethral stenosis or rectourinary fistula who also received prior treatment for prostate cancer. We documented demographics, prostate cancer pretreatment characteristics, prostate cancer therapy type, urethral reconstruction type and success.
  
  
  RESULTS
  A total of 48 patients met the inclusion criteria, including 16 with rectourinary fistula and 32 with urethral stenosis. Urethral complications followed prior radical prostatectomy, brachytherapy, external beam radiotherapy, cryotherapy, thermal ablation and any combination of these procedures. Stenosis repair was successful in 23 of 32 cases (73%) and it differed little between anterior and posterior urethral stenosis. Repair was accomplished by anastomotic urethroplasty in 19 cases, flap urethroplasty in 2, perineal urethrostomy in 2 and a urethral stent in 9. Prior external beam radiotherapy was a risk factor for urethral reconstruction failure. Fistula repair was successful in 14 of 15 patients (93%), excluding 1 who died postoperatively. The complexity of fistula management was dictated by fistula size and the presence or absence of coincident urethral stenosis.
  
  
  CONCLUSIONS
  Urethral stenosis or rectourethral fistula following prostate cancer therapy can be managed by urethral reconstruction, such that normal voiding via the urethra is maintained, rather than abandoning the urethral outlet and performing heterotopic diversion. This can be accomplished with an acceptable rate of failure, given the complexity of the cases.
authors.affiliation: University of California, San Francisco and San Francisco General Hospital, 1001 Potrero Avenue 3A-20, San Francisco, CA 94110, USA. selliott@urol.ucsf.edu
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
authors.forename: Jack W
authors.initials: JW
authors.lastname: McAninch
authors.forename: Thomas
authors.initials: T
authors.lastname: Chi
authors.forename: Sean M
authors.initials: SM
authors.lastname: Doyle
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
mesh_terms: D000368:Aged; D000465:Algorithms; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic; D003286:Contracture / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery / Q000628:therapy; D012003:Rectal Fistula / Q000209:etiology; D014521:Urethra / Q000473:pathology*; D001743:Urinary Bladder / Q000473:pathology; D014548:Urinary Fistula / Q000209:etiology