Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment
| Autor: | Jill C. Buckley, Keith Rourke, Sean P. Elliott, Bryan B. Voelzke, T Wright, Lee C. Zhao, Joshua A. Broghammer, Jeremy B. Myers, Benjamin N. Breyer, Laura Leddy, Nedj F. Alsikafi, Bradley A. Erickson, Alex J. Vanni |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Urethral stricture Urology Urethroplasty medicine.medical_treatment 030232 urology & nephrology Urethral stenosis 03 medical and health sciences Prostate cancer 0302 clinical medicine Recurrence medicine Humans Radiation Injuries Aged Retrospective Studies Aged 80 and over Urethral Stricture Proportional hazards model business.industry Anastomosis Surgical Age Factors Prostatic Neoplasms Middle Aged medicine.disease Surgery Radiation therapy Stenosis Urethra medicine.anatomical_structure 030220 oncology & carcinogenesis Urinary Sphincter Artificial business |
| Zdroj: | Urology. 152 |
| ISSN: | 1527-9995 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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