Efficacy and Incontinence Rates After Urethroplasty for Radiation-induced Urethral Stenosis: A Systematic Review and Meta-analysis

• Published in: Urology (Ridgewood, N.J.) N.J.), 2021-06, Vol.152, p.109-116
• Main Authors: Sapienza, Lucas Gomes, Ning, Matthew Stephen, Carvalho, Emanuel de Freitas, Spratt, Daniel, Calsavara, Vinícius Fernando, McLaughlin, Patrick W., Gomes, Maria Jose Leite, Baiocchi, Glauco, Abu-Isa, Eyad
• Format: Article
• Language: English
• Subjects: Colorectal Neoplasms - radiotherapy; Humans; Male; Prostatic Neoplasms - radiotherapy; Radiotherapy - adverse effects; Urethra - surgery; Urethral Stricture - etiology; Urethral Stricture - surgery; Urinary Incontinence, Stress - etiology; Urologic Surgical Procedures
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2021.02.014

To estimate the efficacy of urethroplasty and rates of de novo stress urinary incontinence (SUI) in the specific setting of radiation-induced urethral stenosis. A systematic search of databases (PubMed and EMBASE) was performed between 1980-2019 (CRD42020144845). Inclusion criteria were: (1) prior pelvic radiotherapy; (2) surgical urethroplasty; (3) rates of successful treatment and/or SUI development and (4) total case number provided. The pooled summary of stenosis resolution rate and SUI were calculated using the random-effects model weighted by the inverse variance. Accessory analyses were performed by reconstructive technique and type of RT. Ninety-six studies were identified, of which 8 retrospective studies met inclusion criteria, comprising 256 patients. The proportion of cases treated with external beam RT (EBRT), brachytherapy (BT), or combination (EBRT+BT) were 52%, 33%, and 15%, respectively, of studies that specified modality. Most strictures involved the bulbomembranous region (n = 212; 83%). Sixty-one percent of cases (n = 157) entailed primary anastomosis, while the remainder underwent augmentation reconstruction (graft or flap). The mean follow-up time after urethroplasty varied from 10 to 50.5 months. The pooled stenosis resolution rate was 80% (95% CI: 74%-86%). There were no significant associations between stenosis resolution rate and reconstructive technique (rho=0.20, P = .74) or RT modality (rho=-0.31, P = .53). Fifty-three cases developed subsequent SUI, with a pooled complication rate of 19% (95% CI: 10%-31%). Urethroplasty after radiation-induced urethral stenosis is effective for 80% of cases, independent of prior RT modality or urethroplasty technique; however, 1 out of every 5 patients develops SUI post-procedure.