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.
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Article info
Publication history
Published online: December 20, 2013
Accepted:
August 16,
2013
Received:
June 5,
2013
Footnotes
Financial Disclosure: S.H. receives royalties from Cook Medical. The remaining authors declare that they have no relevant financial interests.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
