title: Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease.
abstract: OBJECTIVE
  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.
  
  
  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.
authors: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors: Matthias D
authors: MD
authors: Hofer
authors: Department of Urology, University of Texas Southwestern, Dallas, Texas.
authors: Lee C
authors: LC
authors: Zhao
authors: Department of Urology, University of Texas Southwestern, Dallas, Texas.
authors: Allen F
authors: AF
authors: Morey
authors: Department of Urology, University of Texas Southwestern, Dallas, Texas.
authors: J Francis
authors: JF
authors: Scott
authors: Department of Urology, Washington University, St. Louis, Missouri.
authors: Andrew J
authors: AJ
authors: Chang
authors: Department of Urology, Washington University, St. Louis, Missouri.
authors: Steven B
authors: SB
authors: Brandes
authors: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors: Chris M
authors: CM
authors: Gonzalez
mesh_terms: D006801:Humans; D008297:Male; D011832:Radiation Injuries / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: anastomosis; radiotherapy; surgical; urethral stricture