scholarly journals The scope, presentation, and management of genitourinary complications in patients presenting with high-grade urethral complications after radiotherapy for prostate cancer

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
R. Christopher Doiron ◽  
Jon Witten ◽  
Keith F. Rourke
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Artificial Urinary Sphincter ◽  
High Grade ◽  
Radiation Cystitis ◽  
Urinary Sphincter ◽  
Urinary Tract Symptoms ◽  
N 93 ◽  
Mean Time ◽  
Urethral Dilation

Introduction: The scope of complications arising after radiotherapy (RT) treatment for prostate cancer is underrecognized and not well-described. The objective of this study is to describe the presentation, scope, and management of genitourinary complications (GU) in patients referred for high-grade urethral complications or sphincter weakness incontinence after prostate RT. Methods: A retrospective review was performed of patients referred to a reconstructive urologist for management of grade 4 urethral complications and sphincter weakness incontinence after prostate RT from December 2004 to December 2015. Patients’ signs, symptoms, complications, and treatments are described. Results: A total of 120 patients were identified with a mean age of 67.8 years; 55.8% (n=67) received external beam radiotherapy (EBRT), 38.3% (n=46) brachytherapy (BT), and 5.8% (n=7) combination RT. The mean time to first complication after RT was 57.7 months (1–219) and number of complications per patient was 5.12.2. The most common associated complications were urethral stenosis (n=106, 88.3%), sphincter weakness urinary incontinence (n=55, 45.8%), radiation cystitis (n=61, 50.8%), refractory storage lower urinary tract symptoms (n=106, 88.3%), genitourinary pain (n=28, 23.3%), and prostate necrosis/abscess (n=17, 14.2%). Patients required a mean of 7.44.4 treatments over a 33-month period, including urethral dilation/urethrotomy (n= 93, 77.5%), urethroplasty (n=53, 44.2%), transurethral resection (n=52, 43.3%), cystolithopaxy (n=14, 11.7%), artificial urinary sphincter (n=8, 6.7%), and urinary diversion (n=8, 6.7%). Patients with RT combined with other modalities had more complications (6.2 vs. 4.2, p=0.001), higher rates of incontinence (93.8% vs. 29.5%, p=0.001), necrosis (31.3% vs. 8.0%, p=0.003), erectile dysfunction (84.4% vs. 51.1%, p=0.001), and hematuria (59.4% vs. 36.4%, p=0.04). Conclusions: Urethral complications related to prostate RT are seldom an isolated problem and require a substantial amount of urological resources and interventions.

Experience with artificial urinary sphincter implantation in men who underwent prior pelvic radiation therapy for prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 236-236
Author(s):  
Sameer G. Jhavar ◽  
Erin Bird ◽  
Gregory P. Swanson
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Artificial Urinary Sphincter ◽  
Pelvic Radiation ◽  
Urinary Sphincter ◽  
Prior Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

236 Background: To assess outcomes after artificial urinary sphincter implantation in men who received prior pelvic radiation therapy. Methods: Between 1997 and 2012, 107 patients were identified from the Scott and White Hospital database who underwent artificial urinary sphincter implantation for urinary incontinence after prostate cancer treatment. Of these 17 were excluded for lack of follow-up data. Of the remaining 90 patients, 59 patients underwent prior surgery alone (group 1), 25 underwent prior surgery followed by pelvic radiation therapy (group 2); and 6 patients underwent prior radiation therapy alone. Results: Average ages at sphincter implantation were 69 yrs. (range 54 - 82), 73 yrs. (range 63 - 81), and 70 yrs. (range 60 - 80) respectively for groups 1, 2 and 3. Social continence rates were 80% (47/59) for group 1, 72% (18/25) for Group 2 and 50% (3/6) for group 3 at an average follow-up of 6 yrs. (range 0 - 17), 4 yrs. (range 1 - 12) and 3 yrs. (range 0 - 6) respectively. Average time between surgery and sphincter implantation was 5 yrs. (range 1-27) in group 1. Average time between radiation and sphincter implantation was 7 yrs. (range 1 - 18) and 6 yrs. (range 1 - 17) in Groups 2 and 3. Re-operation rates were 42% (25/59); 48% (12/25); and 50% (3/6) in groups 1, 2, and 3, respectively. In men who were incontinent at last follow-up, the average time between pelvic radiation and sphincter placement was relatively shorter as compared to those who were continent [5 yrs. (range 1 -11) vs. 7 yrs. (range 1 - 18) in Group 2; and 4 yrs. (range 1 -5) vs.10 yrs. (range 4 - 17) in group 3]. The rates of erosions were 10/59 (17%); 4/25 (16%); and 0/6 (0%) in groups 1, 2, and 3, respectively. The rates of infection were 5/59 (8%), 0/25 (0%), and 2/6 (33%) in groups 1, 2, and 3, respectively. Conclusions: Our experience with artificial urinary sphincter in men who underwent prior pelvic radiation therapy is comparable to that reported in the literature. Our results identify factors associated with worse continence after artificial urinary sphincter in men who underwent prior pelvic radiation therapy.

scholarly journals Transperineal approach to complex rectourinary fistulae

2015 ◽  
Vol 9 (11-12) ◽  
pp. 916 ◽  
Author(s):  
Henry Tran ◽  
Ryan Flannigan ◽  
Daniel Rapoport
Keyword(s):  
Prostate Cancer ◽  
Cancer Therapy ◽  
External Beam Radiotherapy ◽  
Muscle Flap ◽  
Perineal Wound ◽  
Artificial Urinary Sphincter ◽  
Radical Retropubic Prostatectomy ◽  
Gracilis Muscle ◽  
Adjuvant Radiation ◽  
Gracilis Muscle Flap

<p><strong>Introduction:</strong> We sought to present our experience and outcomes in patients with complex rectourethral fistulae (RUF) treated using the transperineal approach with gracilis muscle flap interposition. Complex RUF was defined as having prior radiation, failed repair attempts, and large size (&gt;2 cm).</p><p><strong>Methods:</strong> A retrospective review identified 10 patients presenting with complex RUF between July 2009 and November 2013. Three were excluded due to large fistula defects managed with urinary diversion. Seven patients met inclusion criteria and underwent reconstruction.</p><p><strong>Results:</strong> Six of 7 patients had prostate cancer, and one patient had colon cancer treated with low anterior resection with adjuvant radiation. The primary modality of prostate cancer therapy was brachytherapy (n=3), external beam radiotherapy (n=2) and radical retropubic prostatectomy (RRP) (n=1). Three patients had salvage cancer therapy, including RRP (n=1), cystoprostatectomy with ileal conduit (n=1), and cryotherapy (n=1). One patient developed RUF post-primary RRP without radiation. Mean fistula size was 2.8cm (2‒4 cm). No fistulas recurred at mean follow-up 11.4 months (6‒20 months). Three patients have had colostomy reversal, one is pending reversal and three have permanent colostomies. Five patients have stress urinary incontinence, with two managed with one to four pads per day, one managed with a condom catheter, and two waiting for artificial urinary sphincter (AUS). One patient developed a perineal wound infection and one developed a pulmonary embolus treated medically.</p><p><strong>Conclusion:</strong> Complex RUF defects are effectively treated with transperineal repair using gracilis muscle interposition. The procedure has low morbidity and high success. Concomitant stress incontinence and bladder outlet contracture are prevalent in this population and may require ongoing management.</p>

Artificial urinary sphincter longevity following transurethral resection of the prostate in the setting of prostate cancer

2019 ◽  
Vol 37 (12) ◽  
pp. 2755-2761
Author(s):  
Andrew J. Cohen ◽  
William Boysen ◽  
Kristine Kuchta ◽  
Sarah Faris ◽  
Jaclyn Milose
Keyword(s):  
Prostate Cancer ◽  
Transurethral Resection ◽  
Artificial Urinary Sphincter ◽  
Urinary Sphincter
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