The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet.

Background To evaluate the safety and efficacy of focal laser ablation (FLA) in low‐intermediate risk prostate cancer. Methods Inclusion criteria were men aged 50–75 years, prostate‐specific antigen (PSA) ≤15 ng/mL, clinical stage T1c–T2a, one or two lesions (PI‐RADS ≥3) on magnetic resonance imaging (MRI), and Gleason score 6 (>3 mm) or Gleason 7 on targeted biopsy. Treatment success was defined as no clinically significant cancer in ablated areas. The study is prospective. Under MRI guidance, laser ablation was applied to the visible lesion(s). International Prostate Symptoms Score, Sexual Health Inventory in Men score and PSA levels were assessed at baseline and repeated at 1, 3, 6, 12 and 18 months. MRI was repeated at 3 and 12 months. Cancer control was assessed at 6 months using targeted and systematic biopsies. Results FLA was performed in 49 patients. Gleason scores were 3 + 3 in 13 patients (26.5%), 3 + 4 in 29 (59.2%) and 4 + 3 in 7 (14.3%). No significant complications were noticed. International Prostate Symptoms Score measurements up to 18 months were not different from baseline (all P > 0.05). Sexual Health Inventory in Men scores dropped in the first year (all P < 0.05), but were not different from baseline levels at 18 months (P = 0.097). PSA levels dropped significantly at 3–18 months (all P < 0.05). Treatment was successful in 39 patients (79.6%). Persistent cancer in treated areas was found in 10 patients (20.4%). Conclusions FLA is safe with no impact on urinary and sexual functions at 18 months follow‐up. Oncologic control is encouraging. Larger scale studies and longer follow‐up are required.

Objective This study evaluated the outcomes of urethroplasty performed in male patients by a single surgeon. Methods A retrospective review of male patients who underwent substitution urethroplasty by a single surgeon was performed. Baseline and perioperative parameters were recorded. Follow‐up involved a pericatheter urethrogram at 3 weeks, a flow study at 8 weeks, and cystoscopic calibration within 6 to 12 months. Patient satisfaction was assessed using the Patient Global Impression of Improvement questionnaire. Primary outcome was functional success, as defined by no need for further intervention. Secondary outcomes were complications, patient satisfaction, and factors associated with stricture recurrence. Results Sixty male patients were included; two were lost to follow‐up. Median patient age was 47 years (range 17–83 years). Mean stricture length was 5 cm (range 1.5–18 cm). Urethroplasty was performed using buccal mucosa graft repair in 53 patients (92%), flap repair in three patients (5%), and a combination of both techniques in two patients (3%). All complications were Clavien–Dindo Grade I to III, recorded in 20 patients (34%). At a mean follow‐up of 50 months (range 12–124 months), functional success was evident in 90% of patients. Cystoscopic calibration at 6 to 18 months was performed in 28 patients (49%). Most patients (93%) reported a better quality of life after the procedure. Oral complications were low grade and uncommon (6%). Stricture recurrence was not related to age, stricture length, or etiology (all P > 0.05). Conclusions Substitution urethroplasty has a high success rate, durable response, and high patient satisfaction. Standardization of surveillance protocol after urethroplasty is recommended.