title: Observations and outcomes of urethroplasty for bulbomembranous stenosis after radiation therapy for prostate cancer.
abstract: OBJECTIVE
  Bulbomembranous stenosis is a significant complication of radiotherapy for prostate cancer. Our purpose is to report outcomes of urethroplasty for radiation-induced bulbomembranous urethral stenoses.
  
  
  METHODS
  Thirty-five patients underwent urethroplasty for refractory radiation-induced bulbomembranous stenoses from January 2004 to November 2013. Patients had a minimum follow-up of 12 months with routine cystoscopy at 6 and 12 months. Primary outcome was urethral patency, and secondary outcomes were 90-day complications, de novo incontinence, de novo erectile dysfunction and bothersome LUTS. Outcomes were compared using Fisher's exact test.
  
  
  RESULTS
  Of the 35 patients, 20 and 15 had stenosis related to external beam radiation therapy and brachytherapy, respectively. Mean stricture length was 3.5 cm. Reconstruction was performed using anastomotic urethroplasty in 23 patients (65.7 %), while 12 required tissue transfer as a buccal mucosa graft (20.0 %) or penile island flap (14.3 %). With 50.5 months of follow-up, thirty patients (85.7 %) achieved cystoscopic patency with no significant difference between techniques (p = 0.32). A 90-day complication rate of 31.4 % was observed (all Clavien 1-2) with no difference between techniques (p = 1.00). Adverse change in continence occurred in 25.7 % of patients (13.3 % in those without previous TURP). Postoperatively, persisting storage LUTS occurred in 40.0 and 30.4 % described adverse change in erectile function (exclusively in the anastomotic urethroplasty group).
  
  
  CONCLUSIONS
  Reconstruction of radiation-induced bulbomembranous stenosis yields satisfying patency rates. However, radiation-induced urethral stenosis is not an isolated problem as many patients suffer from storage symptoms, erectile dysfunction or incontinence as a consequence of treatment either before or after urethroplasty.
authors.affiliation: Division of Urology, University of Alberta, Suite 400 Hys Centre, 11010-101 Street, Edmonton, AB, T5H 4B9, Canada. krourke@ualberta.ca.
authors.forename: Keith
authors.initials: K
authors.lastname: Rourke
authors.affiliation: Division of Urology, University of Alberta, Suite 400 Hys Centre, 11010-101 Street, Edmonton, AB, T5H 4B9, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Kinnaird
authors.affiliation: Division of Urology, University of Alberta, Suite 400 Hys Centre, 11010-101 Street, Edmonton, AB, T5H 4B9, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Zorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D011471:Prostatic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000532:radiotherapy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000528:radiation effects / Q000601:surgery*; D014525:Urethral Stricture / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: Radiotherapy; Surgical; Urethral stenosis; Urethral stricture