The Efficacy and Safety of a Conservative Management Approach to Radiation-Induced Male Urethral Strictures in Elderly Patients With Comorbidities
Abstract
Objectives: To assess the outcomes of a conservative management approach to radiation-induced urethral stricture
disease (R-USD) in an elderly population with comorbidities.
Methods: Patients with R-USD managed with endoscopic procedures and/or clean intermittent catheterization
(CIC) between 2007 and 2019 were included. Patients were excluded if they had an obliterative stricture, prior
urethral reconstruction/urinary diversion surgery, or < 3 months follow-up. Primary outcome measures were
urinary tract infection (UTI), acute urinary retention (AUR), serum creatinine, uroflowmetry/post-void residual,
and urinary incontinence (UI). Failure was defined as progression to reconstructive surgery or permanent indwelling
catheterization.
Results: Ninety-one men were analyzed with a median follow-up of 15.0 months (IQR 8.9 to 37.9). Median age
was 75.4 years (IQR 70.0 to 80.0), body mass index was 26.5 kg/m2 (IQR 24.8 to 30.3), and Charlson comorbidity
index was 6 (IQR 5 to 8). Median stricture length was 2.0 cm (IQR 2.0 to 3.0). Stricture location was bulbar (12%),
bulbomembranous (75%), and prostatic (13%). A total of 90% underwent dilation, and 44% underwent direct visual
internal urethrotomy (DVIU). For those that underwent these procedures, median number of dilations and DVIUs
per patient was 2 (IQR 1 to 5) and 1 (IQR 1 to 3), respectively. Forty percent used CIC. Thirty-four percent developed a
UTI, and 15% had an AUR episode requiring urgent treatment. Creatinine values, uroflowmetry measurements, and
UI rates remained stable. Eighty percent avoided reconstructive surgery or indwelling catheterization.
Conclusion: Most elderly patients with comorbidities with R-USD appear to be effectively managed in the shortterm
with conservative strategies. Close observation is warranted because of the risk of UTIs and AUR. The potential
long-term consequences of repetitive conservative interventions must be considered.
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