Investig Clin Urol.  2016 Sep;57(5):309-315. 10.4111/icu.2016.57.5.309.

Urethral strictures after radiation therapy for prostate cancer

• Moltzahn F
• Dal Pra A
• Furrer M
• Thalmann G
• Spahn M

• KMID: 2427008
• DOI: http://doi.org/10.4111/icu.2016.57.5.309

Abstract

Urethral stricture after radiation therapy for localized prostate cancer is a delicate problem as the decreased availability of tissue healing and the close relation to the sphincter complicates any surgical approach. We here review the pathophysiology, dosimetry, and the disease specific aspects of urethral strictures after radiotherapy. Moreover we discuss different treatment option such as direct vision internal urethrotomy as well as techniques for open reconstruction with and without tissue transfer.

Keyword

Prostate neoplasms; Radiation; Urethral stricture

MeSH Terms

Humans
Male
Prostatic Neoplasms/*radiotherapy
Radiation Injuries/diagnosis/*etiology/physiopathology/surgery
Radiotherapy/adverse effects
Radiotherapy Dosage
Urethral Stricture/diagnosis/*etiology/physiopathology/surgery

Reference

1. SEER Stat fact sheets: prostate cancer [Internet]. Bethesda(MD): National Cancer Institute;2012. cited 2016 Mar 12. Available from: http://seer.cancer.gov/statfacts/html/prost.html.

2. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014; 65:124–137.

3. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014; 65:467–479.

4. Herschorn S, Elliott S, Coburn M, Wessells H, Zinman L. SIU/ICUD Consultation on Urethral Strictures: Posterior urethral stenosis after treatment of prostate cancer. Urology. 2014; 83:3 Suppl. S59–S70.

5. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008; 58:71–96.

6. Hudson SV, O'Malley DM, Miller SM. Achieving optimal delivery of follow-up care for prostate cancer survivors: improving patient outcomes. Patient Relat Outcome Meas. 2015; 6:75–90.

7. Viswanathan AN, Yorke ED, Marks LB, Eifel PJ, Shipley WU. Radiation dose-volume effects of the urinary bladder. Int J Radiat Oncol Biol Phys. 2010; 76:3 Suppl. S116–S122.

8. Aström L, Pedersen D, Mercke C, Holmang S, Johansson KA. Long-term outcome of high dose rate brachytherapy in radiotherapy of localised prostate cancer. Radiother Oncol. 2005; 74:157–161.

9. Liauw SL, Connell PP, Weichselbaum RR. New paradigms and future challenges in radiation oncology: an update of biological targets and technology. Sci Transl Med. 2013; 5:173sr2.

10. Stone HB, Coleman CN, Anscher MS, McBride WH. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol. 2003; 4:529–536.

11. Singh M, Blandy JP. The pathology of urethral stricture. J Urol. 1976; 115:673–676.

12. Hoeller U, Tribius S, Kuhlmey A, Grader K, Fehlauer F, Alberti W. Increasing the rate of late toxicity by changing the score? A comparison of RTOG/EORTC and LENT/SOMA scores. Int J Radiat Oncol Biol Phys. 2003; 55:1013–1018.

13. Díez P, Mullassery V, Dankulchai P, Ostler P, Hughes R, Alonzi R, et al. Dosimetric analysis of urethral strictures following HDR (192)Ir brachytherapy as monotherapy for intermediate- and high-risk prostate cancer. Radiother Oncol. 2014; 113:410–413.

14. Martinez AA, Gonzalez J, Ye H, Ghilezan M, Shetty S, Kernen K, et al. Dose escalation improves cancer-related events at 10 years for intermediate- and high-risk prostate cancer patients treated with hypofractionated high-dose-rate boost and external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2011; 79:363–370.

15. Merrick GS, Butler WM, Wallner KE, Galbreath RW, Anderson RL, Allen ZA, et al. Risk factors for the development of prostate brachytherapy related urethral strictures. J Urol. 2006; 175:1376–1380.

16. Hindson BR, Millar JL, Matheson B. Urethral strictures following high-dose-rate brachytherapy for prostate cancer: analysis of risk factors. Brachytherapy. 2013; 12:50–55.

17. Ghadjar P, Oesch SL, Rentsch CA, Isaak B, Cihoric N, Manser P, et al. Late toxicity and five year outcomes after high-dose-rate brachytherapy as a monotherapy for localized prostate cancer. Radiat Oncol. 2014; 9:122.

18. Mohammed N, Kestin L, Ghilezan M, Krauss D, Vicini F, Brabbins D, et al. Comparison of acute and late toxicities for three modern high-dose radiation treatment techniques for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012; 82:204–212.

19. Elliott SP, Meng MV, Elkin EP, McAninch JW, Duchane J, Carroll PR, et al. Incidence of urethral stricture after primary treatment for prostate cancer: data from CaPSURE. J Urol. 2007; 178:529–534.

20. Zelefsky MJ, Yamada Y, Cohen GN, Sharma N, Shippy AM, Fridman D, et al. Intraoperative real-time planned conformal prostate brachytherapy: post-implantation dosimetric outcome and clinical implications. Radiother Oncol. 2007; 84:185–189.

21. Lawton CA, Bae K, Pilepich M, Hanks G, Shipley W. Long-term treatment sequelae after external beam irradiation with or without hormonal manipulation for adenocarcinoma of the prostate: analysis of radiation therapy oncology group studies 85-31, 86-10, and 92-02. Int J Radiat Oncol Biol Phys. 2008; 70:437–441.

22. Gardner BG, Zietman AL, Shipley WU, Skowronski UE, Mc-Manus P. Late normal tissue sequelae in the second decade after high dose radiation therapy with combined photons and conformal protons for locally advanced prostate cancer. J Urol. 2002; 167:123–126.

23. Zelefsky MJ, Levin EJ, Hunt M, Yamada Y, Shippy AM, Jackson A, et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008; 70:1124–1129.

24. Sandhu AS, Zelefsky MJ, Lee HJ, Lombardi D, Fuks Z, Leibel SA. Long-term urinary toxicity after 3-dimensional conformal radiotherapy for prostate cancer in patients with prior history of transurethral resection. Int J Radiat Oncol Biol Phys. 2000; 48:643–647.

25. Seymore CH, el-Mahdi AM, Schellhammer PF. The effect of prior transurethral resection of the prostate on post radiation urethral strictures and bladder neck contractures. Int J Radiat Oncol Biol Phys. 1986; 12:1597–1600.

26. Sullivan L, Williams SG, Tai KH, Foroudi F, Cleeve L, Duchesne GM. Urethral stricture following high dose rate brachytherapy for prostate cancer. Radiother Oncol. 2009; 91:232–236.

27. Chon BH, Loeffler JS. The effect of nonmalignant systemic disease on tolerance to radiation therapy. Oncologist. 2002; 7:136–143.

28. Jarosek SL, Virnig BA, Chu H, Elliott SP. Propensity-weighted long-term risk of urinary adverse events after prostate cancer surgery, radiation, or both. Eur Urol. 2015; 67:273–280.

29. Msezane LP, Reynolds WS, Gofrit ON, Shalhav AL, Zagaja GP, Zorn KC. Bladder neck contracture after robot-assisted laparoscopic radical prostatectomy: evaluation of incidence and risk factors and impact on urinary function. J Endourol. 2008; 22:97–104.

30. Huang G, Lepor H. Factors predisposing to the development of anastomotic strictures in a single-surgeon series of radical retropubic prostatectomies. BJU Int. 2006; 97:255–258.

31. Erickson BA, Meeks JJ, Roehl KA, Gonzalez CM, Catalona WJ. Bladder neck contracture after retropubic radical prostatectomy: incidence and risk factors from a large single-surgeon experience. BJU Int. 2009; 104:1615–1619.

32. Gillitzer R, Thomas C, Wiesner C, Jones J, Schmidt F, Hampel C, et al. Single center comparison of anastomotic strictures after radical perineal and radical retropubic prostatectomy. Urology. 2010; 76:417–422.

33. Hu JC, Gu X, Lipsitz SR, Barry MJ, D'Amico AV, Weinberg AC, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA. 2009; 302:1557–1564.

34. Hafez AT, El-Assmy A, Dawaba MS, Sarhan O, Bazeed M. Long-term outcome of visual internal urethrotomy for the management of pediatric urethral strictures. J Urol. 2005; 173:595–597.

35. Holm-Nielsen A, Schultz A, Moller-Pedersen V. Direct vision internal urethrotomy. A critical review of 365 operations. Br J Urol. 1984; 56:308–312.

36. Boccon Gibod L, Le Portz B. Endoscopic urethrotomy: does it live up to its promises? J Urol. 1982; 127:433–435.

37. Brandes SB. Radiotherapy-Induced urethral strictures. In : Brandes SB, Morey AF, editors. Advanced male urethral and genital reconstructive surgery. New York: Humana Press;2014. p. 337–350.

38. Rourke K, Kinnaird A, Zorn J. Observations and outcomes of urethroplasty for bulbomembranous stenosis after radiation therapy for prostate cancer. World J Urol. 2016; 34:377–382.

39. Hofer MD, Zhao LC, Morey AF, Scott JF, Chang AJ, Brandes SB, et al. Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease. J Urol. 2014; 191:1307–1312.

40. Ahyai SA, Schmid M, Kuhl M, Kluth LA, Soave A, Riechardt S, et al. Outcomes of ventral onlay buccal mucosa graft urethroplasty in patients after radiotherapy. J Urol. 2015; 194:441–446.