Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life

Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1–8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased on...

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Autores principales:	Francisco E. Martins, Henriette Veiby Holm, Nicolaas Lumen
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	devastated bladder outlet posterior urethral stenosis bladder neck contracture vesicourethral anastomotic stenosis prostate cancer radiation therapy Medicine R
Acceso en línea:	https://doaj.org/article/38560385633c439185361e45a9e531a0
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spelling	oai:doaj.org-article:38560385633c439185361e45a9e531a02021-11-11T17:33:35ZDevastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life10.3390/jcm102149202077-0383https://doaj.org/article/38560385633c439185361e45a9e531a02021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4920https://doaj.org/toc/2077-0383Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1–8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased oncological cure rates, these adverse events do occur, compromising patients’ quality of life. Non-traumatic obstruction of the posterior urethra and bladder neck include membranous and prostatic urethral stenosis and bladder neck stenosis (also known as contracture). The devastated bladder outlet can result from benign conditions, such as neurogenic dysfunction, trauma, iatrogenic causes, or more frequently from complications of oncologic treatment, such as prostate, bladder and rectum. Most posterior urethral stenoses may respond to endoluminal treatments such as dilatation, direct vision internal urethrotomy, and occasionally urethral stents. Although surgical reconstruction offers the best chance of durable success, these reconstructive options are fraught with severe complications and, therefore, are far from being ideal. In patients with prior RT, failed reconstruction, densely fibrotic and/or necrotic and calcified posterior urethra, refractory incontinence or severe comorbidities, reconstruction may not be either feasible or recommended. In these cases, urinary diversion with or without cystectomy is usually required. This review aims to discuss the diagnostic evaluation and treatment options for patients with bladder outlet obstruction with a special emphasis on patients unsuitable for reconstruction of the posterior urethra and requiring urinary diversion.Francisco E. MartinsHenriette Veiby HolmNicolaas LumenMDPI AGarticledevastated bladder outletposterior urethral stenosisbladder neck contracturevesicourethral anastomotic stenosisprostate cancerradiation therapyMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4920, p 4920 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	devastated bladder outlet posterior urethral stenosis bladder neck contracture vesicourethral anastomotic stenosis prostate cancer radiation therapy Medicine R
spellingShingle	devastated bladder outlet posterior urethral stenosis bladder neck contracture vesicourethral anastomotic stenosis prostate cancer radiation therapy Medicine R Francisco E. Martins Henriette Veiby Holm Nicolaas Lumen Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life
description	Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1–8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased oncological cure rates, these adverse events do occur, compromising patients’ quality of life. Non-traumatic obstruction of the posterior urethra and bladder neck include membranous and prostatic urethral stenosis and bladder neck stenosis (also known as contracture). The devastated bladder outlet can result from benign conditions, such as neurogenic dysfunction, trauma, iatrogenic causes, or more frequently from complications of oncologic treatment, such as prostate, bladder and rectum. Most posterior urethral stenoses may respond to endoluminal treatments such as dilatation, direct vision internal urethrotomy, and occasionally urethral stents. Although surgical reconstruction offers the best chance of durable success, these reconstructive options are fraught with severe complications and, therefore, are far from being ideal. In patients with prior RT, failed reconstruction, densely fibrotic and/or necrotic and calcified posterior urethra, refractory incontinence or severe comorbidities, reconstruction may not be either feasible or recommended. In these cases, urinary diversion with or without cystectomy is usually required. This review aims to discuss the diagnostic evaluation and treatment options for patients with bladder outlet obstruction with a special emphasis on patients unsuitable for reconstruction of the posterior urethra and requiring urinary diversion.
format	article
author	Francisco E. Martins Henriette Veiby Holm Nicolaas Lumen
author_facet	Francisco E. Martins Henriette Veiby Holm Nicolaas Lumen
author_sort	Francisco E. Martins
title	Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life
title_short	Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life
title_full	Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life
title_fullStr	Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life
title_full_unstemmed	Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life
title_sort	devastated bladder outlet in pelvic cancer survivors: issues on surgical reconstruction and quality of life
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/38560385633c439185361e45a9e531a0
work_keys_str_mv	AT franciscoemartins devastatedbladderoutletinpelviccancersurvivorsissuesonsurgicalreconstructionandqualityoflife AT henrietteveibyholm devastatedbladderoutletinpelviccancersurvivorsissuesonsurgicalreconstructionandqualityoflife AT nicolaaslumen devastatedbladderoutletinpelviccancersurvivorsissuesonsurgicalreconstructionandqualityoflife
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Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life

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