Brian J. Flynn, MD, presented “Posterior Urethral Stenosis (PUS) After Prostate Cancer Therapy” during the 41st Annual Ralph E. Hopkins Urology Seminar on February 3, 2022, in Jackson Hole, Wyoming.
How to cite: Flynn, Brian J. “Posterior Urethral Stenosis (PUS) After Prostate Cancer Therapy” February 3, 2022. Accessed Nov 2024. https://grandroundsinurology.com/posterior-urethral-stenosis-pus-after-prostate-cancer-therapy/
Posterior Urethral Stenosis (PUS) After Prostate Cancer Therapy – Summary
Brian J. Flynn, MD, Co-Director of Female Pelvic Medicine and Reconstructive Surgery, Reconstructive Urology, and Associate Professor of Urology at the University of Colorado, discusses Posterior Urethral Stenosis (PUS) after prostate cancer therapy and the existing and developing techniques used to address it. Dr. Flynn opens by outlining the sources of PUS, namely prostate cancer therapy (PCT). He explains the risk factors for PUS, emphasizing that these are ischemic strictures. Dr. Flynn explains the patient-dependent nature of PUS clinical evaluation. Depending upon the patient’s history, urodynamics, cystoscopy, and retrograde, urethrography techniques are viable. Dr. Flynn presents an algorithm for surgical treatments for PUS, as outlined in his 2019 AUA Update Series. Dilations or incisions, antifibrotic agents, lower urinary tract reconstruction, or urinary diversion are recommended by Dr. Flynn. He then considers endoscopic techniques, including dilation or transurethral incision (TUI). Dr. Flynn continues with specific PUS treatments, first introducing the emerging Optilume balloon technology. This technique is a form of balloon dilation with a steroid or antifibrotic agent. He continues by discussing the use of a suprapubic catheter, which may be effective in older patients that are not eligible for reconstruction. Dr. Flynn transitions to the newfound advantages of robotic techniques. In the case of Vesicourethral Anastomotic Stenosis (VUAS), Vesicourethral Anastomotic repair (VUAR) is effective. He highlights that robotics allows for VUAR without needing a pubectomy. Dr. Flynn compares EPA urethroplasty and dorsal onlay urethroplasty to treat bulbar membranous urethral stricture (BMUS). BMUS-EPA shows an 86% success rate, but also poses a risk of incontinence (35% stress urinary incontinence (SUI) post-op). Alternatively, buccal mucosa in the post-urethra shows a lower risk of post-op incontinence (8.1% de novo SUI), with similar success rates (83%).
About The 41st 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, emerging surgical techniques, and general urology. Dr. Stoffel presented this lecture during the 41st iteration of the meeting on February 3rd, 2022 in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Brian J. Flynn, MD, is a professor of surgery/urology and fellowship director in Functional and Reconstructive Urology (FRU) at the University of Colorado, Anschutz Medical Center, Division of Urology, in Denver, Colorado. Dr. Flynn earned his medical degree from Temple University in Philadelphia, Pennsylvania. He completed a six-year residency in urology at Geisinger Medical Center in Danville, Pennsylvania, and a one-year fellowship in female urology and reconstructive urology at Duke University in Durham, North Carolina. He is board-certified in urology and female pelvic medicine and reconstructive surgery. Dr. Flynn earned his Bachelor of Science in biomedical engineering from the University of Rochester in Rochester, New York.
Dr. Flynn’s focus is in functional and reconstructive urology with an active
practice in male/female urinary incontinence, voiding dysfunction, urethral stricture disease, and robotic bladder/ureteral reconstructive surgery. He is a national leader in the use of minimally invasive surgical techniques and robotics for the treatment of urinary incontinence, bladder neck contracture, urethral stricture, and ureteral obstruction. He has developed new techniques for AUS, ProACT, bladder neck
reconstruction, and suprapubic catheter placement.
Dr. Flynn has authored numerous clinical papers, surgical videos, and textbook chapters. He has also presented internationally on surgical management of urethral stenosis with an emphasis on non-transecting techniques, post-prostatectomy incontinence, genitourinary fistula, and ureteral stricture disease.
