title: SIU/ICUD Consultation on Urethral Strictures: Posterior urethral stenosis after treatment of prostate cancer.
abstract: Posterior urethral stenosis can result from radical prostatectomy in approximately 5%-10% of patients (range 1.4%-29%). Similarly, 4%-9% of men after brachytherapy and 1%-13% after external beam radiotherapy will develop stenosis. The rate will be greater after combination therapy and can exceed 40% after salvage radical prostatectomy. Although postradical prostatectomy stenoses mostly develop within 2 years, postradiotherapy stenoses take longer to appear. Many result in storage and voiding symptoms and can be associated with incontinence. The evaluation consists of a workup similar to that for lower urinary tract symptoms, with additional testing to rule out recurrent or persistent prostate cancer. Treatment is usually initiated with an endoscopic approach commonly involving dilation, visual urethrotomy with or without laser treatment, and, possibly, UroLume stent placement. Open surgical urethroplasty has been reported, as well as urinary diversion for recalcitrant stenosis. A proposed algorithm illustrating a graded approach has been provided.
authors.affiliation: Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. Electronic address: s.herschorn@utoronto.ca.
authors.forename: Sender
authors.initials: S
authors.lastname: Herschorn
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN.
authors.forename: Sean
authors.initials: S
authors.lastname: Elliott
authors.affiliation: Division of Urology, Baylor College of Medicine, Houston, TX.
authors.forename: Michael
authors.initials: M
authors.lastname: Coburn
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington.
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
authors.affiliation: Lahey Clinic Medical Center, Burlington, MA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Zinman
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects; D032921:Consensus; D003251:Constriction, Pathologic / Q000209:etiology* / Q000628:therapy; D017679:Cryotherapy / Q000009:adverse effects; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000628:therapy*; D012307:Risk Factors; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects; D014521:Urethra / Q000528:radiation effects; D014525:Urethral Stricture / Q000209:etiology* / Q000628:therapy