Managing the Post Radiation Bladder Neck and Proximal Urethral Stricture Challenges

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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.
Category
Urology
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