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PD22-04 SALVAGE OF RECURRENT BULBAR URETHRAL STRICTURE BY REPEAT EXCISION AND PRIMARY ANASTOMOTIC URETHROPLASTY
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
The decision to perform transection vs. non-transection of the corpus spongiosum during urethoplasty is based on stricture characteristics and surgeon preference. A potential benefit of non-transecting technique is preservation of blood supply distal to the site of stricture. The purpose of this study is to review the stricture resolution rate of transecting vs non-transecting urethroplasty utilized by a single surgeon (BJF) to repair bulbar urethral strictures. METHODS: A retrospective review was done of 342 patients who underwent anterior urethroplasty performed by a single surgeon over the previous 11 years. Patients were then excluded from further analysis if there had been prior urethroplasty, stricture location outside the bulbous urethra, or age <18 years. In the transected group, surgical techniques used included excision and primary anastomosis (EPA) and augmented anastomosis. In the non-transected group, surgical techniques used included non-transecting anastomotic urethroplasty and dorsal, ventral, or combination dorsal-ventral buccal grafting. The decision which surgical technique to employ was based on stricture etiology, length and surgeon preference. The primary end-point was stricture resolution in transected vs. nontransected bulbar urethroplasty. Success was defined as freedom from secondary procedures including dilation, urethrotomy, or repeat urethroplasty. RESULTS: One-hundred and fifty-two patients met inclusion criteria. Mean patient age is 42 years and mean follow-up is 63 months. Primary and secondary outcomes are summarized in Table 1. The most common etiologies are idiopathic and trauma occurring in 59% and 30%, respectively, in the transected group and 60% and 32%, respectively, in the non-transected group. CONCLUSIONS: Urethroplasty can be accomplished utilizing a variety of surgical techniques with durable success rates. In this series, transecting and non-transecting bulbar urethroplasty resulted in similar stricture resolution rate. Additional studies are needed to determine if differences may exist in sexual function outcomes and long-term success. Transected
Non-Transected
Number
102
50
Success
83%
84%
0.92
2.3cm (0.3-8cm)
3.9 (1-10cm)
<0.01
51%
54%
0.49
72 (18-137)
45 (2-135)
<0.01
Stricture Length (range) Prior DVIU Mean f/u (months, range)
p-value
Source of Funding: none
PD22-03 HOW DIMINISHED CAVERNOSAL ARTERIAL BLOOD FLOW AFFECTS THE SUCCESS OF ANASTAMOTIC URETHROPLASTY AFTER PELVIC FRACTURE URETHRAL INJURY Craig Hunter*, Walid Shahrour, Pankaj Joshi, Sandesh Surana, Vikram shah Batra, Sanjay Kulkarni, Pune, India INTRODUCTION AND OBJECTIVES: The vascular supply to the urethra is of paramount importance to urethra. Pelvic Fracture Urethral Injury (PFUI) is often accompanied by vascular injury. For patients with erectile dysfunction and PFUI, it has been previously recommended to undergo a preoperative penile Doppler to investigate penile blood flow. In cases when arterial insufficiency (less than 25 ml/sec) is found, it has been recommended to undergo penile revascularization prior to urethroplasty. The aim of our study was to evaluate the success of urethroplasty in patients with diminished cavernosal arterial blood flow. We hypothesized that decreased cavernosal flow led to increase failure rates of anastomotic urethroplasty after PFUI. METHODS: This is a retrospective review from Jan 2013 to September 2013 of those patients who underwent repair of pelvic
e477
fracture urethral defect and whom penile Doppler was available. All patients with pelvic fracture planning to undergo anastamotic urethroplasty obtain a penile Doppler, irrespective of their stated subjective erection abililty. All penile Doppler studies were performed by an outside imaging center, and reports were reviewed. Locally and worldwide, the radiologist is usually performing the study for erectile dysfuction, and as such the report is limited to the cavernosal artery; rarely is the flow of the dorsal penile artery flow reported. All patients underwent progressive perineal anastamotic urethroplasty. Failure was described as need for repeat urethroplasty, visual internal urethrotomy, urethal dilation, or need for indefinite urinary catheter. RESULTS: From January 2013 to September 2013, 103 Pelvic fracture urethral defects were repaired at our institution. 65 patients with follow up and penile Doppler were available for review. Mean age of patient was 26 years (range 17 to 52), and mean follow up of 16 months (range 12 to 21). Among the 65 patients, 14 (25%) had a documented cavernosal artery flow of less than 25 ml/sec bilaterally. Of those 16 patients with documented poor flow, 12 (75%) had successful urethroplasty. 39 of the 49 (80%) patients with adequate flow had successful urethroplasty. CONCLUSIONS: Diminished cavernosal artery flow rates are not predictive of success or failure in PFUI repair. Patients with severe cavernosal artery insufficiency have adequate successful anastamotic urethroplasty after PFUI. A prospective evaluation of the Dorsal Penile Artery may prove to have a more significant correlation to success after PFUI. Source of Funding: None
PD22-04 SALVAGE OF RECURRENT BULBAR URETHRAL STRICTURE BY REPEAT EXCISION AND PRIMARY ANASTOMOTIC URETHROPLASTY Jordan Siegel*, Arabind Panda, Timothy Tausch, Matthew Meissner, Alexandra Klein, Allen Morey, Dallas, TX INTRODUCTION AND OBJECTIVES: To evaluate the results of repeat excision and primary anastomosis (EPA) urethroplasty in cases of recurrent stricture of the bulbar urethra after prior EPA, and to compare these results with those of primary EPA cases. METHODS: We reviewed our database of patients who underwent EPA urethroplasty for bulbar urethral stricture at our tertiary referral center from 2007 to 2014. A total of 898 urethroplasties were performed over the study period. Patients without available data and those with a history of lichen sclerosis, radiation, and/or hypospadias were excluded from analysis. We identified 286 patients who underwent EPA urethroplaty of the bulbar urethra. The surgery was primary in 249 of 286 (87%) and re-operative in 37 of 286 (13%). Among patients undergoing re-operative EPA for bulbar strictures, 18 of 37 (47%) had undergone a prior EPA. Preoperative characteristics and outcomes were compared between patients undergoing primary versus repeat EPA urethroplasty for bulbar urethral stricture. RESULTS: Re-operative EPA in the bulbar urethra was successful in 18 of 18 patients (100%) after prior failed EPA with a mean follow up of 5.7 months (and a range of 1 to 44). The success rate was comparable to that of primary bulbar EPA (235 of 249, or 94%; p¼0.303) with a mean follow up of 3.8 months (and a range of 3 to 52). Mean stricture length was similar between primary EPA (2.0 cm, range 1.0 to 4.5) and repeat EPA (2.0 cm, range 1.0 to 3.5, p¼0.800). Failed endoscopic management prior to urethroplasty was common in both the primary (170 of 249, or 68%) as well as the re-operative setting (14 of 18, or 78%, p¼0.402). No patient developed new onset chordee, erectile dysfunction, or delayed ischemic complications after re-operative urethroplasty.
THE JOURNAL OF UROLOGYâ
e478
CONCLUSIONS: Excision and primary anastomosis has excellent results in recurrent urethral stricture of the bulbar urethra after failed prior EPA. The success rate is comparable to that of primary bulbar EPA.
Source of Funding: none
PD22-05 PERINEAL URETHROSTOMY: A DEFINITIVE CURE FOR ADVANCED URETHRAL STRICTURE DISEASE Michael Belsante*, George Webster, John Patrick Selph, Michael Granieri, Divya Ajay, Andrew Peterson, Durham, NC INTRODUCTION AND OBJECTIVES: While the perineal urethrostomy (PU) has proven to be a highly successful option for patients with complex urethral stricture disease, it is often utilized as a last resort. The perceived disadvantages of this procedure include the loss of normal anatomy, need to sit to urinate, and concerns about potency and sexual function. We aim to describe our contemporary series of patients treated with perineal urethrostomy. METHODS: We conducted an IRB approved, retrospective review of all patients who underwent PU from 1996 to 2012. Inclusion criteria were age > 18 and male gender. Patients with a temporary PU as part of a staged repair were excluded. Data extracted included patient demographics, stricture etiology, comorbidities, previous therapies, and need for subsequent interventions. All patients who received perineal urethrostomy as definitive management were included in the analysis. PU was considered successful if there was no need for subsequent interventions including dilations, self-calibration or surgical revision. RESULTS: A total of 718 patients underwent urethral reconstruction in the studied time period. Of these, 56 received a PU (7.8%). Etiology was lichen sclerosus in 20 (36%), hypospadias in 10 (18%), and trauma or idiopathic in 26 (46%). Mean follow-up was 21 months. All of these cases consisted of creation of a posteriorly based flap perineal urethrostomy as described by Barbagli. Eight out of 56 patients received a PU after electing not to proceed with a planned second stage urethroplasty. Twenty-eight of the 48 (58%) patients who intended to have definitive PU had failed at least one previous urethroplasty compared with 2 of 8 (25%) patients intending to have staged repair (p¼0.1). Of the 56 patients, two patients (3.6%) developed stenosis of the PU. One patient underwent a successful revision of the perineal urethrostomy and the other was placed on self-dilations. Prior radiation, stricture etiology, BMI, diabetes, prior urethroplasty, and stricture length were not predictive of failure. CONCLUSIONS: Perineal urethrostomy is a highly successful technique for severe urethral stricture disease that arrests the need for further interventions in the vast majority of cases with a very low complication or revision rate. Source of Funding: None.
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
PD22-06 RE-OPERATIVE ABDOMINO-PERINEAL RECONSTRUCTIVE SURGERY Simon Bugeja*, Anastasia Frost, Daniela E. Andrich, Anthony R. Mundy, London, United Kingdom INTRODUCTION AND OBJECTIVES: Most re-operative surgery after failed previous reconstruction is transperineal (TP) with a high success rate and low complication rate. In recent years there has been an increasing incidence of patients with complications of surgery or radiotherapy (DXT) particularly, but not exclusively, for pelvic cancer requiring re-operative surgery abdomino-perineally (AP). METHODS: Between June ’09 e July ’14 we performed 104 AP procedures in 91 patients (mean age 54 yrs). In most cases surgery was for uro-intestinal fistulation or other sorts of iatrogenic injury. 59 procedures were for failed surgery to treat complications of treating pelvic cancer; 45 for failed surgery to treat complications of treating benign pelvic pathology. 62 procedures would normally have been performed TP had the patients not already had multiple previous attempts to correct their problem. 6 procedures were in patients who had no surgery or DXT other than their previous/last failed attempt at reconstruction (PLFAAR); 15 procedures in patients who had no surgery other than their PLFAAR but had DXT; 51 procedures in patients who had previous surgery other than their PLFAAR but no DXT; 32 procedures in patients who had both previous AP surgery other than their PLFAAR and DXT. In all, 83 procedures were performed in the 68 patients who had previous surgery and between them they had had 164 previous laparotomies (1-7) other than their PLFAAR. RESULTS: 59 procedures (57%) in 54 patients (60%) were uneventful and all had a satisfactory outcome. 45 procedures (43%) in 37 patients (40%) had 57 complications. 3 patients died, 6 underwent early re-operation for operative complications and 6 needed further surgery to get a satisfactory result, in 3 of whom this was not achieved, giving an overall failure of 3. Looking at the differential effects of previous surgery, DXT or a combination of both, DXT produces a 47% complication rate due to incomplete healing or infective complications. Repeated previous surgery produces a 35% incidence of surgical complications such as bowel leaks; indeed 4 previous laparotomies virtually guarantees a significant postoperative complication. The combination of surgery and DXT carries a 63% complication rate. All the early returns to surgery are in the latter two groups. CONCLUSIONS: Given that half these patients have survived their treatment for pelvic cancer but are left with serious complications, they pay a significant price for their survivorship. This morbidity/mortality may be a relatively small volume workload but is high intensity, timeconsuming and is occurring with increasing frequency and is likely to continue to do so. Source of Funding: None
PD22-07 INCIDENCE, TIMING, AND MANAGEMENT OF URETHRAL STRICTURE FOLLOWING PRIMARY RADIATION THERAPY FOR PROSTATE CANCER Timothy Baumgartner*, James Ebertowski, Edith Canby-Hagino, Steven Hudak, San Antonio, TX INTRODUCTION AND OBJECTIVES: Urethral stricture is a well-known complication of pelvic radiation therapy (RT) for prostate cancer, occurring in approximately 2-11% of men depending on modality of RT administered. The object of this study was to evaluate our institutional experience with urethral stricture following RT for prostate cancer. METHODS: The San Antonio Military Medical Center Tumor Registry was queried to identify men who underwent primary RT for prostate cancer between the years 2000 and 2006. Inpatient and
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
The decision to perform transection vs. non-transection of the corpus spongiosum during urethoplasty is based on stricture characteristics and surgeon preference. A potential benefit of non-transecting technique is preservation of blood supply distal to the site of stricture. The purpose of this study is to review the stricture resolution rate of transecting vs non-transecting urethroplasty utilized by a single surgeon (BJF) to repair bulbar urethral strictures. METHODS: A retrospective review was done of 342 patients who underwent anterior urethroplasty performed by a single surgeon over the previous 11 years. Patients were then excluded from further analysis if there had been prior urethroplasty, stricture location outside the bulbous urethra, or age <18 years. In the transected group, surgical techniques used included excision and primary anastomosis (EPA) and augmented anastomosis. In the non-transected group, surgical techniques used included non-transecting anastomotic urethroplasty and dorsal, ventral, or combination dorsal-ventral buccal grafting. The decision which surgical technique to employ was based on stricture etiology, length and surgeon preference. The primary end-point was stricture resolution in transected vs. nontransected bulbar urethroplasty. Success was defined as freedom from secondary procedures including dilation, urethrotomy, or repeat urethroplasty. RESULTS: One-hundred and fifty-two patients met inclusion criteria. Mean patient age is 42 years and mean follow-up is 63 months. Primary and secondary outcomes are summarized in Table 1. The most common etiologies are idiopathic and trauma occurring in 59% and 30%, respectively, in the transected group and 60% and 32%, respectively, in the non-transected group. CONCLUSIONS: Urethroplasty can be accomplished utilizing a variety of surgical techniques with durable success rates. In this series, transecting and non-transecting bulbar urethroplasty resulted in similar stricture resolution rate. Additional studies are needed to determine if differences may exist in sexual function outcomes and long-term success. Transected
Non-Transected
Number
102
50
Success
83%
84%
0.92
2.3cm (0.3-8cm)
3.9 (1-10cm)
<0.01
51%
54%
0.49
72 (18-137)
45 (2-135)
<0.01
Stricture Length (range) Prior DVIU Mean f/u (months, range)
p-value
Source of Funding: none
PD22-03 HOW DIMINISHED CAVERNOSAL ARTERIAL BLOOD FLOW AFFECTS THE SUCCESS OF ANASTAMOTIC URETHROPLASTY AFTER PELVIC FRACTURE URETHRAL INJURY Craig Hunter*, Walid Shahrour, Pankaj Joshi, Sandesh Surana, Vikram shah Batra, Sanjay Kulkarni, Pune, India INTRODUCTION AND OBJECTIVES: The vascular supply to the urethra is of paramount importance to urethra. Pelvic Fracture Urethral Injury (PFUI) is often accompanied by vascular injury. For patients with erectile dysfunction and PFUI, it has been previously recommended to undergo a preoperative penile Doppler to investigate penile blood flow. In cases when arterial insufficiency (less than 25 ml/sec) is found, it has been recommended to undergo penile revascularization prior to urethroplasty. The aim of our study was to evaluate the success of urethroplasty in patients with diminished cavernosal arterial blood flow. We hypothesized that decreased cavernosal flow led to increase failure rates of anastomotic urethroplasty after PFUI. METHODS: This is a retrospective review from Jan 2013 to September 2013 of those patients who underwent repair of pelvic
e477
fracture urethral defect and whom penile Doppler was available. All patients with pelvic fracture planning to undergo anastamotic urethroplasty obtain a penile Doppler, irrespective of their stated subjective erection abililty. All penile Doppler studies were performed by an outside imaging center, and reports were reviewed. Locally and worldwide, the radiologist is usually performing the study for erectile dysfuction, and as such the report is limited to the cavernosal artery; rarely is the flow of the dorsal penile artery flow reported. All patients underwent progressive perineal anastamotic urethroplasty. Failure was described as need for repeat urethroplasty, visual internal urethrotomy, urethal dilation, or need for indefinite urinary catheter. RESULTS: From January 2013 to September 2013, 103 Pelvic fracture urethral defects were repaired at our institution. 65 patients with follow up and penile Doppler were available for review. Mean age of patient was 26 years (range 17 to 52), and mean follow up of 16 months (range 12 to 21). Among the 65 patients, 14 (25%) had a documented cavernosal artery flow of less than 25 ml/sec bilaterally. Of those 16 patients with documented poor flow, 12 (75%) had successful urethroplasty. 39 of the 49 (80%) patients with adequate flow had successful urethroplasty. CONCLUSIONS: Diminished cavernosal artery flow rates are not predictive of success or failure in PFUI repair. Patients with severe cavernosal artery insufficiency have adequate successful anastamotic urethroplasty after PFUI. A prospective evaluation of the Dorsal Penile Artery may prove to have a more significant correlation to success after PFUI. Source of Funding: None
PD22-04 SALVAGE OF RECURRENT BULBAR URETHRAL STRICTURE BY REPEAT EXCISION AND PRIMARY ANASTOMOTIC URETHROPLASTY Jordan Siegel*, Arabind Panda, Timothy Tausch, Matthew Meissner, Alexandra Klein, Allen Morey, Dallas, TX INTRODUCTION AND OBJECTIVES: To evaluate the results of repeat excision and primary anastomosis (EPA) urethroplasty in cases of recurrent stricture of the bulbar urethra after prior EPA, and to compare these results with those of primary EPA cases. METHODS: We reviewed our database of patients who underwent EPA urethroplasty for bulbar urethral stricture at our tertiary referral center from 2007 to 2014. A total of 898 urethroplasties were performed over the study period. Patients without available data and those with a history of lichen sclerosis, radiation, and/or hypospadias were excluded from analysis. We identified 286 patients who underwent EPA urethroplaty of the bulbar urethra. The surgery was primary in 249 of 286 (87%) and re-operative in 37 of 286 (13%). Among patients undergoing re-operative EPA for bulbar strictures, 18 of 37 (47%) had undergone a prior EPA. Preoperative characteristics and outcomes were compared between patients undergoing primary versus repeat EPA urethroplasty for bulbar urethral stricture. RESULTS: Re-operative EPA in the bulbar urethra was successful in 18 of 18 patients (100%) after prior failed EPA with a mean follow up of 5.7 months (and a range of 1 to 44). The success rate was comparable to that of primary bulbar EPA (235 of 249, or 94%; p¼0.303) with a mean follow up of 3.8 months (and a range of 3 to 52). Mean stricture length was similar between primary EPA (2.0 cm, range 1.0 to 4.5) and repeat EPA (2.0 cm, range 1.0 to 3.5, p¼0.800). Failed endoscopic management prior to urethroplasty was common in both the primary (170 of 249, or 68%) as well as the re-operative setting (14 of 18, or 78%, p¼0.402). No patient developed new onset chordee, erectile dysfunction, or delayed ischemic complications after re-operative urethroplasty.
THE JOURNAL OF UROLOGYâ
e478
CONCLUSIONS: Excision and primary anastomosis has excellent results in recurrent urethral stricture of the bulbar urethra after failed prior EPA. The success rate is comparable to that of primary bulbar EPA.
Source of Funding: none
PD22-05 PERINEAL URETHROSTOMY: A DEFINITIVE CURE FOR ADVANCED URETHRAL STRICTURE DISEASE Michael Belsante*, George Webster, John Patrick Selph, Michael Granieri, Divya Ajay, Andrew Peterson, Durham, NC INTRODUCTION AND OBJECTIVES: While the perineal urethrostomy (PU) has proven to be a highly successful option for patients with complex urethral stricture disease, it is often utilized as a last resort. The perceived disadvantages of this procedure include the loss of normal anatomy, need to sit to urinate, and concerns about potency and sexual function. We aim to describe our contemporary series of patients treated with perineal urethrostomy. METHODS: We conducted an IRB approved, retrospective review of all patients who underwent PU from 1996 to 2012. Inclusion criteria were age > 18 and male gender. Patients with a temporary PU as part of a staged repair were excluded. Data extracted included patient demographics, stricture etiology, comorbidities, previous therapies, and need for subsequent interventions. All patients who received perineal urethrostomy as definitive management were included in the analysis. PU was considered successful if there was no need for subsequent interventions including dilations, self-calibration or surgical revision. RESULTS: A total of 718 patients underwent urethral reconstruction in the studied time period. Of these, 56 received a PU (7.8%). Etiology was lichen sclerosus in 20 (36%), hypospadias in 10 (18%), and trauma or idiopathic in 26 (46%). Mean follow-up was 21 months. All of these cases consisted of creation of a posteriorly based flap perineal urethrostomy as described by Barbagli. Eight out of 56 patients received a PU after electing not to proceed with a planned second stage urethroplasty. Twenty-eight of the 48 (58%) patients who intended to have definitive PU had failed at least one previous urethroplasty compared with 2 of 8 (25%) patients intending to have staged repair (p¼0.1). Of the 56 patients, two patients (3.6%) developed stenosis of the PU. One patient underwent a successful revision of the perineal urethrostomy and the other was placed on self-dilations. Prior radiation, stricture etiology, BMI, diabetes, prior urethroplasty, and stricture length were not predictive of failure. CONCLUSIONS: Perineal urethrostomy is a highly successful technique for severe urethral stricture disease that arrests the need for further interventions in the vast majority of cases with a very low complication or revision rate. Source of Funding: None.
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
PD22-06 RE-OPERATIVE ABDOMINO-PERINEAL RECONSTRUCTIVE SURGERY Simon Bugeja*, Anastasia Frost, Daniela E. Andrich, Anthony R. Mundy, London, United Kingdom INTRODUCTION AND OBJECTIVES: Most re-operative surgery after failed previous reconstruction is transperineal (TP) with a high success rate and low complication rate. In recent years there has been an increasing incidence of patients with complications of surgery or radiotherapy (DXT) particularly, but not exclusively, for pelvic cancer requiring re-operative surgery abdomino-perineally (AP). METHODS: Between June ’09 e July ’14 we performed 104 AP procedures in 91 patients (mean age 54 yrs). In most cases surgery was for uro-intestinal fistulation or other sorts of iatrogenic injury. 59 procedures were for failed surgery to treat complications of treating pelvic cancer; 45 for failed surgery to treat complications of treating benign pelvic pathology. 62 procedures would normally have been performed TP had the patients not already had multiple previous attempts to correct their problem. 6 procedures were in patients who had no surgery or DXT other than their previous/last failed attempt at reconstruction (PLFAAR); 15 procedures in patients who had no surgery other than their PLFAAR but had DXT; 51 procedures in patients who had previous surgery other than their PLFAAR but no DXT; 32 procedures in patients who had both previous AP surgery other than their PLFAAR and DXT. In all, 83 procedures were performed in the 68 patients who had previous surgery and between them they had had 164 previous laparotomies (1-7) other than their PLFAAR. RESULTS: 59 procedures (57%) in 54 patients (60%) were uneventful and all had a satisfactory outcome. 45 procedures (43%) in 37 patients (40%) had 57 complications. 3 patients died, 6 underwent early re-operation for operative complications and 6 needed further surgery to get a satisfactory result, in 3 of whom this was not achieved, giving an overall failure of 3. Looking at the differential effects of previous surgery, DXT or a combination of both, DXT produces a 47% complication rate due to incomplete healing or infective complications. Repeated previous surgery produces a 35% incidence of surgical complications such as bowel leaks; indeed 4 previous laparotomies virtually guarantees a significant postoperative complication. The combination of surgery and DXT carries a 63% complication rate. All the early returns to surgery are in the latter two groups. CONCLUSIONS: Given that half these patients have survived their treatment for pelvic cancer but are left with serious complications, they pay a significant price for their survivorship. This morbidity/mortality may be a relatively small volume workload but is high intensity, timeconsuming and is occurring with increasing frequency and is likely to continue to do so. Source of Funding: None
PD22-07 INCIDENCE, TIMING, AND MANAGEMENT OF URETHRAL STRICTURE FOLLOWING PRIMARY RADIATION THERAPY FOR PROSTATE CANCER Timothy Baumgartner*, James Ebertowski, Edith Canby-Hagino, Steven Hudak, San Antonio, TX INTRODUCTION AND OBJECTIVES: Urethral stricture is a well-known complication of pelvic radiation therapy (RT) for prostate cancer, occurring in approximately 2-11% of men depending on modality of RT administered. The object of this study was to evaluate our institutional experience with urethral stricture following RT for prostate cancer. METHODS: The San Antonio Military Medical Center Tumor Registry was queried to identify men who underwent primary RT for prostate cancer between the years 2000 and 2006. Inpatient and