RESUMO
OBJECTIVE: 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. METHODS: 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. RESULTS: 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 (Pâ¯=â¯.02), stricture length (P <.0001) and combined modality radiotherapy (Pâ¯=â¯.004) as factors associated with stricture recurrence while body mass index (Pâ¯=â¯.79), diabetes (Pâ¯=â¯.93), smoking (Pâ¯=â¯.62), failed endoscopic treatment (Pâ¯=â¯.08) and gracilis muscle use (Pâ¯=â¯.25) were not. On multivariate analysis, increasing patient age (H.R.1.09, 95%CI 1.01-1.16; Pâ¯=â¯.02) and stenosis length (H.R.2.62, 95%CI 1.49-4.60; Pâ¯=â¯.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. CONCLUSIONS: 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.
