The Devastated Bladder Outlet in Cancer Survivors After Local Therapy for Prostate Cancer

Prostate cancer is common; this combined with the long life expectancy after treatment has sparked a growing emphasis on prostate cancer survivorship care. An important goal of such care is preserving quality of life through ameliorating the side effects of therapy. Posterior urethral stenosis (PUS) can occur as a complication of radical prostatectomy (RP) and radiation therapy (RT). Evaluation includes a history, physical exam, uroflowmetry, lab tests, cystoscopy, and radiological studies. PUS is initially managed with endoscopic techniques such as dilation or internal urethrotomy. Patients who fail such therapies can be offered surgical reconstruction. Continence is an important factor in the management of PUS. In some cases, particularly after radiotherapy, the outlet may not be salvageable, and a permanent indwelling catheter or urinary diversion may be the only options. We review the evaluation of patients with the devastated bladder outlet: those undergoing repeat endoscopic treatments, surgical reconstruction, or urinary diversion.