Urinary Diversions After Radiation for Prostate Cancer: Indications and Treatment

Faris, Sarah; Milam, Douglas F.; Dmochowski, Roger R.; Kaufman, Melissa R.

doi:10.1016/j.urology.2014.04.023

Cited by 25 publications

(21 citation statements)

References 13 publications

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“…This fact highlights the severity of the RT UAEs. Two other groups recently described similar reasons for diversion after radiation for PCa including fistula, end‐stage bladder, devastated outlet, and a combination of bladder and outlet problems .…”

Section: Discussionmentioning

confidence: 88%

Management of Radiation Therapy Oncology Group grade 4 urinary adverse events after radiotherapy for prostate cancer

et al. 2016

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ObjectiveTo describe the management of Radiation Therapy Oncology Group (RTOG) grade 4 urinary adverse events (UAEs) after radiotherapy (RT) for prostate cancer (PCa). MethodsWe conducted a single-centre retrospective review, over a 6-year period (2010)(2011)(2012)(2013)(2014)(2015), to identify men with RTOG grade 4 UAEs after RT for PCa. RT was classified as combined therapy (radical prostatectomy [RP] followed by external beam radiotherapy [EBRT], EBRT + low-dose-rate [LDR] brachytherapy, EBRT + high-dose-rate [HDR] brachytherapy or other combinations of RT) or monotherapy RT. UAEs were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto-urethral fistula) or bladder (contraction, necrosis, fistula, ureteric stricture or haemorrhage) UAEs. ResultsWe identified 73 men with a mean age of 73 years. Of these, 44 (60%) received combined therapy, consisting of RP + EBRT (n = 19), HDR brachytherapy + EBRT (n = 19), LDR brachytherapy + EBRT (n = 5), and other combined RT (n = 1). Twenty-nine (40%) patients had monotherapy consisting of EBRT (n = 4), HDR brachytherapy (n = 11), LDR brachytherapy (n = 12), or proton beam therapy (n = 2). UAEs were isolated to the bladder in six men (8%), the outlet in 52 men (71%), and to both in 15 men (21%). UAE management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion (UD) in 23 men (32%). Reconstruction included: ureteric (n = 4), recto-urethral fistula repair (n = 2), and posterior urethroplasty (n =13), of which 14/16 surgeries (88%) with follow-up >90 days were successful. ConclusionsAlthough the incidence of RTOG grade 4 UAEs after PCa radiation treatment is not well defined, their associated morbidity is significant, and approximately one third of patients with these high-grade complications require UD. Conversely, only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients.

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Section: Discussionmentioning

confidence: 88%

Management of Radiation Therapy Oncology Group grade 4 urinary adverse events after radiotherapy for prostate cancer

et al. 2016

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“…The combination of sphincteric damage and recurrent stricture or stenosis, after multiple failed attempts at repair of both, the so called ‘devastated outlet’ is difficult to rectify and has little existing literature to support appropriate management pathways (77,78). Similarly, the end stage bladder is often seen subsequent to radiotherapy.…”

Section: Managementmentioning

confidence: 99%

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

Nicholson

Al-Hakeem

Maldonado

et al. 2017

Transl. Androl. Urol.

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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.

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“…Faris et al. looked at urinary diversions after radiation for prostate cancer and noted that the average time between radiation treatment to presentation was 4.6 years. We noted a similar figure, with a median time since treatment of 4 years.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy‐related complications presenting to a urology department: a more common problem than previously thought?

et al. 2018

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Urinary Diversions After Radiation for Prostate Cancer: Indications and Treatment

Cited by 25 publications

References 13 publications

Management of Radiation Therapy Oncology Group grade 4 urinary adverse events after radiotherapy for prostate cancer

Management of Radiation Therapy Oncology Group grade 4 urinary adverse events after radiotherapy for prostate cancer

Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer

Radiotherapy‐related complications presenting to a urology department: a more common problem than previously thought?

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