Urethroplasty for radiotherapy induced XXXX : a multi-institutional experience.

@entity1 @entity323 @entity263 @entity322 @entity384 @entity254 @entity3832 @entity850 @entity11044
PURPOSE: Radiotherapy induced @entity3832 are often difficult to manage due to proximal location, compromised vascular supply and poor wound healing. To determine the success of urethroplasty for radiation induced strictures we performed a multi-institutional review of @entity1 who underwent urethroplasty for @entity11044 . MATERIALS AND METHODS: A total of 30 @entity1 (mean age 67 years) underwent urethroplasty at 3 separate institutions. Excision with primary @entity254 was used in 24 of 30 @entity1 (80%), with 4 of 30 requiring a genital fasciocutaneous skin flap and 2 a buccal graft. Hospitalization was less than 23 hours for 70% of the @entity1 . Recurrence was defined as cystoscopic identification of urethral narrowing to less than 16Fr in diameter. RESULTS: All strictures were located in the bulbomembranous region. Mean stricture length was 2.9 cm (range 1.5 to 7). External beam radiotherapy for @entity263 was the etiology of @entity850 in 15 @entity1 (50%), with brachytherapy in 7 (24%) and a combination of the 2 modalities in 8 (26%). Successful urethral reconstruction was achieved in 22 @entity1 (73%) at a mean of 21 months. Mean time to stricture recurrence was 5.1 months (range 2 to 8). Two @entity1 required @entity384 after stricture recurrence and none required urinary diversion. @entity322 was transient in 10% and persistent in 40%, with 13% requiring an artificial urinary sphincter. The rate of @entity323 was unchanged following urethroplasty (47% preoperative, 50% postoperative). CONCLUSIONS: Urethroplasty for radiation induced strictures has an acceptable rate of success and can be performed without tissue transfer techniques in most cases. Almost half of @entity1 will experience some degree of @entity322 as a result of surgery but erectile function appears to be preserved.
