Mayo ClinicEndoscopic Buccal Mucosal Grafting for Radiation-induced Membranous Urethral Strictures

Innovative Approach in Treating Radiation-Induced Membranous Urethral Strictures

The management of membranous urethral strictures, particularly those resulting from radiation therapy for prostate cancer, presents a significant clinical challenge. Dr. Nick Warner, a urologist at Mayo Clinic, has pioneered a minimally invasive technique aimed at addressing this complication without necessitating incisions. This new method, which has been detailed in a study published in a 2023 issue of Urology and presented at the American Urological Association (AUA) annual meeting, offers a promising alternative to traditional surgical interventions, potentially revolutionizing treatment paradigms and patient outcomes in this complex area.

Key Points:

• Radiation therapy for prostate cancer, effective for targeting cancerous cells, often results in collateral damage to surrounding healthy tissues, causing side effects like urinary problems and, more rarely, membranous urethral stricture.
• Membranous urethral stricture occurs in the section of the urethra that runs through pelvic muscles, a complication arising from tissue damage due to radiation, posing significant treatment challenges due to its location and the involvement of the continence mechanism.
• The diagnostic work-up for this condition includes cystoscopy for direct visualization, voiding cystourethrogram in certain cases, uroflow measurement, and the International Prostate Symptom Score to assess symptom severity.
• Traditional management strategies range from self-catheterization, which carries risks of pain and infection, to surgical excision and primary anastomosis, often leading to postoperative incontinence and complications in subsequent anti-incontinence procedures.
• Dr. Warner’s technique involves a series of minimally invasive steps: cystoscopy, dilation, scar tissue resection, deployment of a buccal graft, and catheter placement, showing promising results in maintaining urethral patency and improving patient outcomes without the need for extensive surgery.
• This method not only reduces operative time and avoids scrotal incisions but also preserves the urethral structure in a way that facilitates future interventions for urinary incontinence, a common postoperative challenge.

The overall reported incidence of urethral stricture after RT for PCa varies between 0%–18 %. The majority of series report rates after BT between 3%–10%, 1%–12% after EBRT, and higher rates after the combination of both. However, more recent data using modern LDR-BT and IMRT techniques describe lower rates down to 3%.

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