Post-prostate Ca treatment stricture, fistula can be managed successfully

The urethral strictures and fistulas that sometimes follow localized prostate cancer treatments can be challenging, but skill and experience can often overcome the challenge, according to a study from the University of Colorado Hospital, Aurora, presented yesterday.

Study co-authors David Hadley, MD, and Brian Flynn, MD, reported success rates with reconstructive surgical procedures ranging from 60% to 100%. The 37 complications that were surgically resolved included recto-urinary fistula (15), radiation-induced cystitis (three), anterior urethral stricture (three), vesicourethral stricture (11), and radionecrosis (five).

“These can be difficult surgeries and each presents different problems. Anterior repairs can usually be augmented or excised with great success. Posterior strictures, however, can be significantly more difficult because of access and exposure,” Dr. Hadley told Urology Times.

Despite the study’s seemingly small data set, it is one of the larger and more comprehensive studies of its kind, said Dr. Hadley. This testifies to the relative rarity of these complications.

No single initial procedure in this data set seemed to be associated with a specific complication, Dr. Hadley said. However, he did observe that a history of radiation therapy was more likely to be predictive of reconstructive failure.

"It is less likely that you will see a urethral stricture after open or robotic surgery as compared to radiation, at least not an anterior urethral stricture," he said. "An anastomotic stricture, or bladder neck contracture, is much more likely. Although a perineal, or a combined perineal and abdominal, approach has typically been described to repair refractory or obliterative anastomotic strictures, we advocate an abdominal approach with pubectomy, as we feel continence is better preserved."