Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment

B B Voelzke; L S Leddy; J B Myers; B N Breyer; N F Alsikafi; J A Broghammer; S P Elliott; A J Vanni; B A Erickson; J C Buckley; L C Zhao; T Wright; K F Rourke; Trauma and Urologic Reconstructive Network of Surgeons (TURNS)

doi:10.1016/j.urology.2020.11.077

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Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment

Journal article

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Peer reviewed

Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment

B B Voelzke, L S Leddy, J B Myers, B N Breyer, N F Alsikafi, J A Broghammer, S P Elliott, A J Vanni, B A Erickson, J C Buckley, …

Urology (Ridgewood, N.J.), Vol.152, pp.117-122

06/2021

DOI: 10.1016/j.urology.2020.11.077

PMID: 33556448

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https://escholarship.org/content/qt6635f334/qt6635f334.pdf?t=qorve0View

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Abstract

To evaluate the outcomes of excision and primary anastomosis (EPA) for radiation-associated bulbomembranous stenoses using a multi-institutional analysis. The treatment of radiation-associated urethral stenosis is typically complex owing to the adverse impact of radiation on adjacent tissue. An IRB-approved multi-institutional retrospective review was performed on patients who underwent EPA for bulbomembranous urethral stenosis following prostate radiotherapy. Preoperative patient demographics, operative technique, and postoperative outcomes were abstracted from 1/2007-6/2018. Success was defined as voiding per urethra without the need for endoscopic treatment and a minimum follow-up of 12 months. One hundred and thirty-seven patients from 10 centers met study criteria with a mean age of 69.3 years (50-86), stenosis length of 2.3 cm (1-5) and an 86.9% (119/137) success rate at a mean follow-up 32.3 months (12-118). Univariate Cox regression analysis identified increasing patient age (P = .02), stricture length (P <.0001) and combined modality radiotherapy (P = .004) as factors associated with stricture recurrence while body mass index (P = .79), diabetes (P = .93), smoking (P = .62), failed endoscopic treatment (P = .08) and gracilis muscle use (P = .25) were not. On multivariate analysis, increasing patient age (H.R.1.09, 95%CI 1.01-1.16; P = .02) and stenosis length (H.R.2.62, 95%CI 1.49-4.60; P = .001) remained associated with recurrence. Subsequent artificial urinary sphincter was performed in 30 men (21.9%), of which 25 required a transcorporal cuff and 5 developed cuff erosion. EPA for radiation-associated urethral stenosis effectively provides unobstructed instrumentation-free voiding. However, increasing stenosis length and age are independently associated with surgical failure. Patients should be counseled that further surgery for incontinence may be necessary.

Age Factors

Aged

Aged, 80 and over

Anastomosis, Surgical

Humans

Male

Middle Aged

Prostatic Neoplasms - radiotherapy

Radiation Injuries - surgery

Recurrence

Retrospective Studies

Urethral Stricture - etiology

Urethral Stricture - surgery

Urinary Sphincter, Artificial - statistics & numerical data

Details

Title: Subtitle: Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment
Creators: B B Voelzke - University of Washington
L S Leddy - University of Washington
J B Myers - University of Utah
B N Breyer - University of California San Francisco Medical Center
N F Alsikafi - UroPartners, Chicago, IL.
J A Broghammer - University of Kansas Medical Center
S P Elliott - University of Minnesota
A J Vanni - Lahey Hospital and Medical Center
B A Erickson - University of Iowa
J C Buckley - University of California San Diego
L C Zhao - NYU Langone Health
T Wright - Washington State University Spokane
K F Rourke - University of Alberta
Trauma and Urologic Reconstructive Network of Surgeons (TURNS)
Resource Type: Journal article
Publication Details: Urology (Ridgewood, N.J.), Vol.152, pp.117-122
DOI: 10.1016/j.urology.2020.11.077
PMID: 33556448
NLM abbreviation: Urology
ISSN: 0090-4295
eISSN: 1527-9995
Language: English
Date published: 06/2021
Academic Unit: Urology
Record Identifier: 9984319982002771

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