Management of Urethral Stricture and Bladder Neck Contracture Following Primary and Salvage Treatment of Prostate Cancer

Abstract

Rates of stenosis after prostate cancer treatment appear similar across all primary treatment modalities including radical prostatectomy, radiation therapy, cryoablation, and high-intensity focused ultrasound in contemporary series. Urethral dilation and urethrotomy continue to report moderate patency rates. Urethroplasty achieves high patency rates even for long strictures, but more extensive reconstruction increases the risk of postoperative urinary incontinence. Recent AUA guidelines on urethral strictures provide new recommendations for management of these patients. All treatment options for prostate cancer carry a risk for bladder outlet obstruction, and intervention is often necessary to relieve long-lasting morbidity. Careful preoperative evaluation should be completed to assess location and extent of the stricture in order to choose optimal therapy. Endoscopic treatments, open reconstruction, and urinary diversion all play a role in relief of stenosis depending on stricture length, location, characteristics, and patient comorbidities.

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The clinical significance of COL5A2 in patients with bladder cancer

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“…In 2006, Sacco et al [26] showed a 2.4-fold higher RR of remaining incontinent after RRP, if the patient developed stenosis. It is likely that management of stenosis by transurethral incision leads to a higher risk of long-term complications, with postrepair urinary incontinence being the most severe complication [27]. Another mechanism could be the negative influence of scar tissue on the external sphincter and its function in continence control.…”