TY - JOUR AU - Rozanski, Alexander T. AU - Moynihan, Matthew J. AU - Zhang, Lawrence T. AU - Muise, Alexandra C. AU - Holst, Daniel D. AU - Copacino, Steven A. AU - Zinman, Leonard N. AU - Buckley, Jill C. AU - Vanni, Alex J. PY - 2022/01/04 Y2 - 2024/03/29 TI - The Efficacy and Safety of a Conservative Management Approach to Radiation-Induced Male Urethral Strictures in Elderly Patients With Comorbidities JF - Société Internationale d'Urologie Journal JA - Soc Int Urol J VL - 3 IS - 1 SE - Original Research DO - 10.48083/XFYL6260 UR - https://siuj.org/index.php/siuj/article/view/158 SP - 14-20 AB - Objectives: To assess the outcomes of a conservative management approach to radiation-induced urethral stricturedisease (R-USD) in an elderly population with comorbidities.Methods: Patients with R-USD managed with endoscopic procedures and/or clean intermittent catheterization(CIC) between 2007 and 2019 were included. Patients were excluded if they had an obliterative stricture, priorurethral reconstruction/urinary diversion surgery, or < 3 months follow-up. Primary outcome measures wereurinary tract infection (UTI), acute urinary retention (AUR), serum creatinine, uroflowmetry/post-void residual,and urinary incontinence (UI). Failure was defined as progression to reconstructive surgery or permanent indwellingcatheterization.Results: Ninety-one men were analyzed with a median follow-up of 15.0 months (IQR 8.9 to 37.9). Median agewas 75.4 years (IQR 70.0 to 80.0), body mass index was 26.5 kg/m2 (IQR 24.8 to 30.3), and Charlson comorbidityindex was 6 (IQR 5 to 8). Median stricture length was 2.0 cm (IQR 2.0 to 3.0). Stricture location was bulbar (12%),bulbomembranous (75%), and prostatic (13%). A total of 90% underwent dilation, and 44% underwent direct visualinternal urethrotomy (DVIU). For those that underwent these procedures, median number of dilations and DVIUsper patient was 2 (IQR 1 to 5) and 1 (IQR 1 to 3), respectively. Forty percent used CIC. Thirty-four percent developed aUTI, and 15% had an AUR episode requiring urgent treatment. Creatinine values, uroflowmetry measurements, andUI rates remained stable. Eighty percent avoided reconstructive surgery or indwelling catheterization.Conclusion: Most elderly patients with comorbidities with R-USD appear to be effectively managed in the shorttermwith conservative strategies. Close observation is warranted because of the risk of UTIs and AUR. The potentiallong-term consequences of repetitive conservative interventions must be considered. ER -