Endourethral brachytherapy for prevention of recurrent urethral stricture following internal urethrotomy--first clinical experiences and results

Abstract

Purpose: To evaluate the therapeutic effect of endourethral brachytherapy for prevention of recurrent urethral stricture after internal urethrotomy.

Materials and methods: Endourethral high-dose-rate (HDR) brachytherapy was performed in 10 male patients with recurrent urethral strictures after radical prostatectomy or transurethral resection of prostatic adenoma. Brachytherapy commenced on the day of the actual intervention and continued over 3 days; the radiotherapy dose was 4 x 3 = 12 Gy for the first 3 patients and 4 x 4 Gy = 16 Gy for the following 7 patients.

Results: During follow-up (range: 8-27 months, mean: 14.8 months), 9 of 10 patients remained relapse-free, i.e., without recurrent strictures or requiring another urethrotomy. In 1 patient with a restricture after endourethral brachytherapy, a second brachytherapy course was performed; nevertheless, he experienced a further restricture 12 months after the second intervention. No radiation-induced acute toxicity occurred, but 1 patient developed incontinence after the current urethrotomy. Overall, patient satisfaction and compliance with the therapeutic procedures was high.

Conclusions: Endourethral HDR brachytherapy proved to be a safe method that can reduce urethral restricture. Further follow-up is needed to prove long-term efficacy of this treatment. Further investigations are planned to evaluate the adequate fractionation and possible late treatment sequelae.