Jay Simhan, MD, FACS, presented “Managing the Post Radiation Bladder Neck and Proximal Urethral Stricture Challenges” during the 44th Annual Ralph E. Hopkins Urology Seminar on February 5, 2025, in Jackson Hole, Wyoming.
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How to cite: Simhan, Jay. “Managing the Post Radiation Bladder Neck and Proximal Urethral Stricture Challenges.” February 5, 2025. Accessed Mar 2025. https://grandroundsinurology.com/managing-the-post-radiation-bladder-neck-and-proximal-urethral-stricture-challenges/
Managing the Post Radiation Bladder Neck and Proximal Urethral Stricture Challenges – Summary
Jay Simhan, MD, FACS, explores the challenges of post-radiation bladder neck and proximal urethral strictures, emphasizing their complex management and evolving treatment paradigms. In this 18-minute presentation, Dr. Simhan highlights the historical reliance on excisional urethroplasty with primary anastomosis but notes the shift from this approach due to concerns about compromised blood supply and erectile dysfunction.
Dr. Simhan discusses the increasing preference for non-transecting urethroplasty, which preserves vascular integrity and reduces the risk of erectile dysfunction. He underscores the distinct challenges radiated strictures pose, making surgical reconstruction especially difficult. Various surgical techniques, including dorsal onlay grafts and perineal approaches, are reviewed, stressing the importance of preserving urethral tissue.
Dr. Simhan critiques robotic reconstructive approaches in radiated patients, citing poor outcomes and high failure rates. He presents multi-institutional data demonstrating improved success with non-transecting perineal reconstruction and grafting techniques. He warns against using mitomycin C injections due to severe complications, including bladder neck necrosis and the need for urinary diversion.
Dr. Simhan advocates a patient-specific approach, favoring perineal non-transecting reconstruction over robotic surgery in radiated survivors to maintain urethral integrity and optimize long-term continence management.
About The 44th Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, sexual function, emerging surgical techniques, and general urology. The 44th iteration of the meeting took place from February 5th to February 8th, 2025, in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Jay Simhan, MD, FACS, is a chair at Temple Department of Urology, Professor of Urology, Lewis Katz School of Medicine at Temple University, Fellowship Director, GURS Reconstruction and Prosthetics, and a Professor of Urology at Fox Chase Cancer Center in Philadelphia, Pennsylvania. Additionally, Dr. Simhan serves as the fellowship director of the reconstructive and prosthetic urology fellowship program. He is also a member of the executive management team at the Fox Chase - Temple Urologic Institute. Dr. Simhan earned his medical degree from the University of North Carolina, Chapel Hill. He completed general surgery and urology residencies at Temple University Hospital and Fox Chase Cancer Center, and he completed additional fellowship training in urologic trauma, reconstruction, and prosthetics at the University of Texas Southwestern in Dallas. Dr. Simhan has completed additional executive leadership training at the Wharton School at the University of Pennsylvania in Philadelphia.
Dr. Simhan is an active and contributing member of the American Urologic Association, American College of Surgeons, the Society of Genitourinary Reconstructive Surgeons, Société Internationale d’Urologie, Society of Urologic Prosthetic Surgeons, and the Sexual Medicine Society of North America. Dr. Simhan currently serves as fellowship committee chair and a member of the board of directors of the Society of Genitourinary Reconstructive Surgeons.
