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 Dec 2022. 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.