Department of Urology, University of California, San Francisco, San Francisco General Hospital, San Francisco, California 94117, USA.
Urology. 2012 Jun;79(6):1402-5. doi: 10.1016/j.urology.2011.11.077. Epub 2012 Apr 21.
To report urethroplasty outcomes in men who developed urethral stricture after undergoing radiation therapy for prostate cancer.
Our urethroplasty database was reviewed for cases of urethral stricture after radiation therapy for prostate cancer between June 2004 and May 2010. Patient demographics, prostate cancer therapy type, stricture length and location, and type of urethroplasty were obtained. All patients received clinical evaluation, including imaging studies post procedure. Treatment success was defined as no need for repeat surgical intervention.
Twenty-nine patients underwent urethroplasty for radiation-induced stricture. Previous radiation therapy included external beam radiotherapy (EBRT), radical prostatectomy (RP)/EBRT, EBRT/brachytherapy (BT) and BT alone in 11 (38%), 7 (24%), 7 (24%), and 4 (14%) patients, respectively. Mean age was 69 (±6.9) years. Mean stricture length was 2.6 (±1.6) cm. Anastomotic urethroplasty was performed in 76% patients, buccal mucosal graft in 17%, and perineal flap repair in 7%. Stricture was localized to bulbar urethra in 12 (41%), membranous in 12 (41%), vesicourethra in 3 (10%), and pan-urethral in 2 (7%) patients. Overall success rate was 90%. Median follow-up was 40 months (range 12-83). Time to recurrence ranged from 6-16 months.
Multiple forms of urethroplasty appear to be viable options in treating radiation-induced urethral stricture. Future studies are needed to examine the durability of repairs.
报告因前列腺癌放射治疗而发生尿道狭窄的患者接受尿道成形术的结果。
我们回顾了 2004 年 6 月至 2010 年 5 月期间因前列腺癌放射治疗后发生尿道狭窄的病例。获取了患者的人口统计学资料、前列腺癌治疗类型、狭窄长度和位置以及尿道成形术类型。所有患者均接受了包括术后影像学检查在内的临床评估。治疗成功定义为无需再次手术干预。
29 例患者因放射诱导的狭窄而行尿道成形术。既往放射治疗包括外照射放疗（EBRT）、根治性前列腺切除术（RP）/EBRT、EBRT/近距离放疗（BT）和 BT 单独治疗的患者分别为 11 例（38%）、7 例（24%）、7 例（24%）和 4 例（14%）。平均年龄为 69（±6.9）岁。平均狭窄长度为 2.6（±1.6）cm。吻合口尿道成形术在 76%的患者中进行，颊黏膜移植在 17%的患者中进行，会阴皮瓣修复在 7%的患者中进行。狭窄部位位于球部尿道 12 例（41%）、膜部尿道 12 例（41%）、膀胱尿道 3 例（10%）和全尿道 2 例（7%）。总体成功率为 90%。中位随访时间为 40 个月（12-83 个月）。复发时间为 6-16 个月。
多种形式的尿道成形术似乎是治疗放射性尿道狭窄的可行选择。未来需要研究来检查修复的耐久性。
