Outcomes and Complications After Intervention for Postradiation Prostatic Urethral Stenosis.

Objective: To study and report on treatment outcomes after surgical intervention for postradiation prostatic urethral stenosis.

Methods: A retrospective chart review was performed, identifying all patients treated at our institution from July 2014-June 2018 with the ICD-10 code N42.89 for prostatic urethral stenosis.

Results: Twenty-two patients were identified with the diagnosis of prostatic urethral stenosis. Patients who had less than 3 months of follow up or etiologies other than postradiation were excluded from analysis. 16 patients were included in the final analysis with an average follow up of 2.6 years (range 3 months to 6.8 years). Average age was 74 years (range 63-84). The average number of interventions performed before referral to a reconstructive urologist was 2.2 (range 0-6). Following referral, an additional 1.2 procedures were performed. Transurethral resection of prostate was the most common intervention, performed in 11 patients; urethroplasty was performed in 2 and the remainder underwent endoscopic incision or dilation. None of the urethroplasty patients required any further intervention for recurrent stenosis. Five patients became severely incontinent and required placement of an artificial urinary sphincter.

Conclusion: Prostatic urethral stenosis is a rare complication occurring after radiotherapy for prostate cancer. Endoscopic management can be successful in stabilizing patients, while urethroplasty can be feasibly performed in patients with short prostatic apical strictures.