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

被引:43
作者
Browne, Brendan Michael [1 ]
Vanni, Alex J. [1 ]
机构
[1] Lahey Hosp & Med Ctr, Dept Urol, 41 Mall Rd, Burlington, MA 01805 USA
关键词
Post-radiation stricture; Urethral stricture; Vesicourethral anastomotic stenosis; Bladder neck contracture; Urethroplasty; INTENSITY FOCUSED ULTRASOUND; VESICOURETHRAL ANASTOMOTIC STRICTURES; VISUAL INTERNAL URETHROTOMY; DOSE-RATE BRACHYTHERAPY; BUCCAL MUCOSA GRAFT; RADICAL PROSTATECTOMY; RADIATION-THERAPY; TRANSURETHRAL RESECTION; ENDOSCOPIC TREATMENT; RISK-FACTORS;
D O I
10.1007/s11934-017-0729-0
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose of Review This article discusses the incidence, evaluation, and treatment of bladder outlet obstruction from urethral stricture, vesicourethral anastomotic stricture, and bladder neck contracture following primary and salvage treatment of prostate cancer. Recent Findings 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. Summary 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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页数:9
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