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 Oct 2026. 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 Professor and Chair of the Department of Urology at Temple University Hospital and the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania. He also serves as Director of Reconstruction and Prosthetics at Fox Chase Cancer Center, Fellowship Director of the Reconstructive and Prosthetic Urology Fellowship Program, and holder of the Carol and Louis Della Penna Chair in Urologic Cancer Survivorship.
An internationally recognized reconstructive urologist, Dr. Simhan specializes in complex urinary tract reconstruction, genitourinary trauma, urethral stricture disease, male urinary incontinence, erectile dysfunction, Peyronie's disease, and urologic prosthetic surgery. His clinical expertise includes open and robotic reconstruction, penile implants, artificial urinary sphincters, and revision surgery for patients with complex urologic conditions. He is particularly focused on restoring urinary and sexual function and improving quality of life following cancer treatment.
Dr. Simhan earned his medical degree from the University of North Carolina at Chapel Hill. He completed his general surgery and urology residencies at Temple University Hospital and Fox Chase Cancer Center, followed by fellowship training in urologic trauma, reconstruction, and prosthetics at the University of Texas Southwestern Medical Center in Dallas, Texas. He also completed executive leadership training at the Wharton School of the University of Pennsylvania.
An accomplished researcher, educator, and author, Dr. Simhan has contributed extensively to peer-reviewed publications and clinical research focused on urologic reconstruction, prosthetic surgery, surgical innovation, and patient-reported outcomes. He is actively involved in national and international professional organizations, including the American Urological Association, American College of Surgeons, Society of Genitourinary Reconstructive Surgeons (GURS), Society of Urologic Prosthetic Surgeons, and Sexual Medicine Society of North America. He serves on the Board of Directors of GURS and has held leadership responsibilities overseeing reconstructive urology fellowship education and training.
