title: Management of radiation-induced urethral strictures.
abstract: Radiation as a treatment option for prostate cancer has been chosen by many patients. One of the side effects encountered are radiation-induced urethral strictures which occur in up to 11% of patients. Radiation damage has often left the irradiated field fibrotic and with poor vascularization which make these strictures a challenging entity to treat. The mainstay of urologic management remains an urethroplasty procedure for which several approaches exist with variable optimal indication. Excision and primary anastomoses are ideal for shorter bulbar strictures that comprise the majority of radiation-induced urethral strictures. One advantage of this technique is that it does not require tissue transfers and success rates of 70-95% have consistently been reported. Substitution urethroplasty using remote graft tissue such as buccal mucosa are indicated if the length of the stricture precludes a tension-free primary anastomosis. Despite the challenge of graft survival in radiation-damaged and poorly vascularized recipient tissue, up to 83% of patients have been treated successfully although the numbers described in the literature are small. The most extensive repairs involve the use of tissue flaps, for example gracilis muscle, which may be required if the involved periurethral tissue is unable to provide sufficient vascular support for a post-operative urethral healing process. In summary, radiation-induced urethral strictures are a challenging entity. Most strictures are amenable to excision and primary anastomosis (EPA) with encouraging success rates but substitution urethroplasty may be indicated when extensive repair is needed.
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Hofer
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gonzalez
keywords: Radiation; review; urethral stricture
references.citation: Brachytherapy. 2013 Jan-Feb;12(1):50-5
references.pmid: 22561217
references.citation: J Urol. 2007 Aug;178(2):529-34; discussion 534
references.pmid: 17570425
references.citation: Clin Plast Surg. 1993 Jul;20(3):435-53
references.pmid: 8324983
references.citation: BJU Int. 2006 Apr;97(4):871-89
references.pmid: 16536795
references.citation: Arch Surg. 2008 Jan;143(1):46-52; discussion 52
references.pmid: 18209152
references.citation: J Urol. 1988 Feb;139(2):294-7
references.pmid: 3276926
references.citation: J Urol. 2000 Apr;163(4):1070-5
references.pmid: 10737469
references.citation: J Urol. 2007 Jun;177(6):2106-31
references.pmid: 17509297
references.citation: J Urol. 2002 Mar;167(3):1314-7
references.pmid: 11832721
references.citation: Urology. 2014 Mar;83(3 Suppl):S59-70
references.pmid: 24361008
references.citation: Eur Urol. 2013 Sep;64(3):440-7
references.pmid: 23759258
references.citation: J Natl Compr Canc Netw. 2014 May;12(5):686-718
references.pmid: 24812137
references.citation: Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):204-12
references.pmid: 21167653
references.citation: J Oral Maxillofac Surg. 2008 Apr;66(4):739-44
references.pmid: 18355598
references.citation: BJU Int. 2011 Jan;107(1):6-26
references.pmid: 21176068
references.citation: Eur Urol. 2011 Jul;60(1):60-8
references.pmid: 21419566
references.citation: J Urol. 2006 Dec;176(6 Pt 1):2508-13
references.pmid: 17085144
references.citation: J Clin Oncol. 1997 Jan;15(1):223-9
references.pmid: 8996146
references.citation: Urology. 2012 Jun;79(6):1402-5
references.pmid: 22521189
references.citation: Eur Urol. 2015 Feb;67(2):273-80
references.pmid: 25217421
references.citation: Radiother Oncol. 2009 May;91(2):232-6
references.pmid: 19097660
references.citation: J Urol. 2002 Jan;167(1):123-6
references.pmid: 11743288
references.citation: J Urol. 2015 Mar;193(3):902-5
references.pmid: 25261802
references.citation: J Urol. 2014 May;191(5):1307-12
references.pmid: 24333513
references.citation: J Urol. 2011 May;185(5):1761-5
references.pmid: 21420123