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One of the most common causes of bladder outflow obstruction in post radiotherapy (RT) cases is urethral stenosis. These cases are miserable and moribund with poor flow rates, incomplete bladder emptying, recurrent urinary tract infections and haematuria. The reported incidence of stenosis following RT is as high as 11% with combined external beam RT and brachytherapy. The membranous urethra with varying degrees of extension into the proximal bulbar urethra is a common location for stenosis. The complications of bulbomembranous urethral reconstruction include recurrent stenosis along with de novo or worsening incontinence and erectile dysfunction. These conditions, when associated with bother, can result in a significant adverse impact on quality of life and patient satisfaction. Such patients often get passed about between urologists and oncologists. Stenosis / strictures cannot be treated by optical urethrotomy because of the risk of incontinence. These cases usually need S-shaped dilatation on guide wire and lifelong postoperative intermittent catheterisation. This study will be of interest to urologists who have to manage very difficult or recurrent disease. The paper presents results of anastomotic urethroplasty in such cases with 19 years of follow-up and quality of life assessment. In addition, following urethroplasty for RT-induced stenosis, placement of a male sling or artificial urinary sphincter may be further complicated by both the history of RT and compromise to the anterior urethra from mobilisation and transection. Several studies, often with relatively short-term follow-up, have evaluated the short- and intermediate-term patency rates for both excisional and augmentation-based surgical approaches, and document that there is a risk of worsening erectile function and/or continence after surgery. Long term follow-up is required in such cases.

Long term follow-up suggests high satisfaction rates for bulbo-membranous radiation induced urethral stenosis treated with anastomotic urethroplasty.
Barnard J, Liaw A, Gelman J.
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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