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Radiation Therapy Stricture?

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Posted 6/11/2020 3:32 PM (GMT 0)
Has anybody had a stricture caused by Radiation Therapies (HDRBT and or IMRT)?

If so, where is the location of the stricture and how did you handle the stricture?

Thx,

Akai
Posted 6/11/2020 6:07 PM (GMT 0)
I had both HDR brachy and IMRT and I haven't had a stricture, so unfortunately I can't help with your question. I have had somewhat reduced flow following my treatment, but it's remedied with the occasional Rapaflo. If I may ask...have you actually been diagnosed at this point and how bad is your flow? I'm guessing it's beyond what can be helped by Flomax or Rapaflo?
Posted 6/11/2020 7:26 PM (GMT 0)
Michael, I had a complete blockage while I was on vacation abroad and ended up in an emergency room. The urologist did a DVIU, that was in March of 2019. Its been 15 months and it is back, I am trying to decide which treatments to follow as HDRBT and IMRT complicate the healing process of the tissue around the urethra.
Posted 6/11/2020 8:35 PM (GMT 0)
If you enter stricture AND prostate in the search box, you will find many threads. Hopefully, some will be relevant to you.
Posted 6/11/2020 8:56 PM (GMT 0)
akai...that sure sounds like a rough one. And sorry to hear it's back. Looking at your signature we had the exact same treatment, down to adding Zytiga to the ADT regimen. Wishing you the best of luck.
Posted 6/12/2020 1:38 AM (GMT 0)
I wonder if Gelman would tell you the same thing as Doumanian has. Might be worth comparing their prognosis for you. More information if nothing else. I understand the stress of these things. Mine was never radiated so can’t help you there. (Simple dilation anyway)

Gelman’s done 1,400 of them (according to his website). Reads as if it’s all he does.

Someone else here may have the personal experience your looking for.

.
Posted 6/13/2020 1:13 AM (GMT 0)
Hi island, it was not Dr. Doumanian that cautioned me not to do the urethroplasty, it was the urologist that originally did my DVIU when I was on vacation in Bangkok. Dr. Doumanian offered to do the urethroplasty, he did not mention past radiation may cause healing complications. I suggested urethroplasty but we did not have an opportunity to actually discuss any details. I am trying to get an appointment to do retrograde urethrogram to assess the length of the stricture and perhaps evaluate if surgery should be proceeded but Dr. Doumanian has been very busy.
Since this is a major surgery, I am also trying to get a second opinion/consult with other urologist(s). Dr. Gelman does not accept Medicare insurance, so his labor is completely out of pocket.

Akai
Posted 6/13/2020 4:40 AM (GMT 0)

akai said...
Hi island, it was not Dr. Doumanian that cautioned me not to do the urethroplasty, it was the urologist that originally did my DVIU when I was on vacation in Bangkok. Dr. Doumanian offered to do the urethroplasty, he did not mention past radiation may cause healing complications. I suggested urethroplasty but we did not have an opportunity to actually discuss any details. I am trying to get an appointment to do retrograde urethrogram to assess the length of the stricture and perhaps evaluate if surgery should be proceeded but Dr. Doumanian has been very busy.
Since this is a major surgery, I am also trying to get a second opinion/consult with other urologist(s). Dr. Gelman does not accept Medicare insurance, so his labor is completely out of pocket.

Akai

My bad. I mistakenly assumed that the consult with Dr. Doumanian had already occurred with him telling you the radiation might through a wild card into your prognosis. And that's what motivated you to seek others' experiences. With this kind of surgery, your thinking on a second opinion certainly seems prudent. And thank you for adding the status of where you are with the testing. (I was wondering about that). There's probably not a lot of information floating around about urethroplasty after radiation. (at least on this board). Your in the best of hands. My money is on Doumanian being able to fix that thing.

Please keep us posted on what the docs say. A 3mm positive margin from my surgery puts me in at a higher risk for SRT.. Should my PSA ever rise due to the margin, that stricture of mine could play a role in whether or not I have SRT..

Do try and keep us in the loop. Thanks and good luck to you. (I think Doumanian will fix it. That's what I think)

edit: whoever fixes it, I'd certainly want to know what their experiences have shown them (and how much of it they've got) regarding urethroplasty post radiation treatments. Don't let 'em squirm out of answering that one. Red flag if they try. Good luck man.
Posted 6/13/2020 3:04 PM (GMT 0)
Island, here is the discouraging study on urethroplasty after radiation therapies.
This is what set me into the panic mode.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017559/#!po=79.4118

Long term success rate is low plus healing complications.
Posted 6/13/2020 4:25 PM (GMT 0)

akai said...
...here is the discouraging study on urethroplasty after radiation therapies.
This is what set me into the panic mode. Long term success rate is low plus healing complications.
Urethral strictures after radiation therapy for prostate cancer

Following this thread so I can find it later after my next Uro visit late next month. The article makes only brief mention of adjuvant or SRT following RP, but recently I've had difficulty with restricted flow which may require another AUS revision or possible urethral dilation (or worse). I feel I can no longer trust my current urologist, so I'm facing yet another quest to find a competent specialist. Oh Quap. This scheisse just never ends.

ICurology said...
Patients undergoing surgery should be informed about the chances of stricture recurrence. Moreover they need to know about a new or impairment of a pre-existing incontinence, especially for membranous strictures or after previous TURP or RP. Nonsuitable patients should be informed about alternative (palliative) methods such as intermittent self-catheterization. A continent vesicostomy or urinary diversion might be an alternative for patients with devastated bladder outlet (combination of stricture and incontinence).

Posted 6/13/2020 8:02 PM (GMT 0)

akai said...
Island, here is the discouraging study on urethroplasty after radiation therapies.
This is what set me into the panic mode.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017559/#!po=79.4118

Long term success rate is low plus healing complications.

It makes mine hurt just reading about it. I did not know that there is more than one kind of urethroplasty.

My take away from studying that study (as well as other readings I've done)….is that the length of the stricture is everything. From the study you're looking at, it seems If the stricture is around 3 cm or less... The success rate at 4 years is 90% in one study. The success rate at 4 years in the other study was 70%. "Time to recurrence" does not apply to the success stories. (Only to the failures). "Time to recurrence" only applies to the 10% of failures in the one study and to the 30% of failures in the larger study.

That's how I'm reading it. (but, I'm no expert at reading studies).

The failure rates I believe you may be referring to applies to longer strictures (6 cm) using graph flap as opposed to EPA's. Maybe read it again after reading how I'm interpreting it. At the end of the day, only a some testing and a good doc can determine.....

"..... If open surgery is planned, the careful evaluation of the actual stricture, patient counseling and patient selection are basic requirements for a successful treatment. The surgeon should be experienced with all the techniques of open stricture surgery. Even in experienced hands, success rates decrease with the extent of tissue damage and stricture length. For short strictures EPA should be the first choice, as onlay techniques are required for longer strictures."

Man...I"ll tell ya what akai. I don't envy ya buddy. There is nothing fun about strictures.....period. The incontinence issue, while not at all trying to minimize it (it's never minimal when you're the one facing this stuff)….I think your doctor should have a pretty good handle on what to expect there. It may not be a given. And there's different levels of incontinence. To my mind....we may not be talking about zero control. But, that (as well as all of this) is why we talk to doctors.

If I ever do SRT....I"ll be in pretty much the same place as you are right now. (Unless I went ahead and had a urethroplasty in anticipation of SRT....which....in my mind anyway....seems ludicrous).
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