Posterior urethral stenosis after prostate cancer treatment: contemporary options for definitive management

Kahokehr, Arman; Peterson, Andrew C.; Lentz, Aaron

doi:10.21037/tau.2018.04.04

Cited by 7 publications

(3 citation statements)

References 60 publications

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“…A post-void residual should be measured to ensure the bladder can empty prior to AUS. Kahokehr et al developed an algorithm for treatment of posterior stenoses and recommend stability of >3 months, prior to AUS implantation (98).…”

Section: Posterior Urethral Stenosismentioning

confidence: 99%

Management of male stress urinary incontinence in high-risk patients: a narrative review

Lin¹,

Skokan²,

Wessells³

et al. 2023

Transl Androl Urol

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Background and Objectives: The artificial urinary sphincter (AUS) remains the gold standard for treatment of stress urinary incontinence (SUI). However, highly complex patients such as those with bulbar urethral compromise, bladder pathology, and lower urinary complications pose a particular challenge for the surgeon. In this article, we will address critical risk factors and synthesize existent data across relevant disease states to support surgeons in successful management of SUI in high-risk patients.Methods: A comprehensive review of current literature was performed utilizing the search term "artificial urinary sphincter" in conjunction with any of the following additional terms: "radiation", "urethral stricture", "posterior urethral stenosis", "vesicourethral anastomotic stenosis", "bladder neck contracture", "pelvic fracture urethral injury", "penile revascularization", "inflatable penile prosthesis", and "erosion". Guidance is provided based upon expert opinion where existing literature was sparse or nonexistent.Key Content and Findings: Several known patient risk factors are associated with AUS failure and can ultimately lead to device explantation. Each risk factor requires careful consideration and investigation, or intervention as appropriate, prior to device placement. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients. Several surgical strategies to decrease device complications can be considered: optimization of testosterone, avoidance of 3.5 cm AUS cuff, transcorporal AUS cuff placement, relocation of AUS cuff site, use of lower pressure-regulating balloon, penile revascularization, and intermittent nocturnal deactivation.Conclusions: A number of patient risk factors are associated with AUS failure and can ultimately lead to device explantation. We present an algorithm for management of high-risk patients. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients.

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Section: Posterior Urethral Stenosismentioning

confidence: 99%

Management of male stress urinary incontinence in high-risk patients: a narrative review

Lin¹,

Skokan²,

Wessells³

et al. 2023

Transl Androl Urol

View full text Add to dashboard Cite

show abstract

“…However, other authors reported more positive results [ 82 , 84 ]. Globally, given the severity of these reported complications, although uncommon, antifibrotic agents, particularly MMC, do need to be used with caution, and preferable inside the framework of a clinical trial [ 84 , 85 ].…”

Section: Managementmentioning

confidence: 99%

“…Radiation therapy and ablation-energy modalities (cryotherapy, HIFU) may cause posterior urethral necrosis, sloughing, cavitation, stenosis, and significant bladder dysfunction making these devastated bladder outlets “non-reconstructable”. These patients as well as patients with significant medical comorbidities are best managed with urinary diversion, mainly if a urethral or suprapubic tube are not tolerated by the patient due to bladder pain or spasms [ 85 , 91 , 99 ]. Other reasons to abandon the vesicourethral outlet are intractable hematuria and fistulation.…”

Section: Managementmentioning

confidence: 99%

Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life

Martins

Holm

Lumen

2021

JCM

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Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1–8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased oncological cure rates, these adverse events do occur, compromising patients’ quality of life. Non-traumatic obstruction of the posterior urethra and bladder neck include membranous and prostatic urethral stenosis and bladder neck stenosis (also known as contracture). The devastated bladder outlet can result from benign conditions, such as neurogenic dysfunction, trauma, iatrogenic causes, or more frequently from complications of oncologic treatment, such as prostate, bladder and rectum. Most posterior urethral stenoses may respond to endoluminal treatments such as dilatation, direct vision internal urethrotomy, and occasionally urethral stents. Although surgical reconstruction offers the best chance of durable success, these reconstructive options are fraught with severe complications and, therefore, are far from being ideal. In patients with prior RT, failed reconstruction, densely fibrotic and/or necrotic and calcified posterior urethra, refractory incontinence or severe comorbidities, reconstruction may not be either feasible or recommended. In these cases, urinary diversion with or without cystectomy is usually required. This review aims to discuss the diagnostic evaluation and treatment options for patients with bladder outlet obstruction with a special emphasis on patients unsuitable for reconstruction of the posterior urethra and requiring urinary diversion.

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Posterior urethral stenosis: Contemporary management options

Yu,

Ahmed,

Murray

et al. 2024

UroPrecision

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Posterior urethral stenosis (PUS) is a known complication following prostate cancer treatment as well as other benign endoscopic treatments. Patients with PUS often fail initial endoscopic treatments and have persistent symptoms negatively affecting quality of life. In the past decade, a variety of different surgical techniques and approaches have changed the landscape of PUS management. The goal of this review is to provide details on the historical, current, and future direction of the surgical management for PUS.

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Posterior urethral stenosis after prostate cancer treatment: contemporary options for definitive management

Cited by 7 publications

References 60 publications

Management of male stress urinary incontinence in high-risk patients: a narrative review

Management of male stress urinary incontinence in high-risk patients: a narrative review

Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life

Posterior urethral stenosis: Contemporary management options

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