Posterior urethral complications of the treatment of prostate cancer

What's known on the subject? and What does the study add? Urethral strictures, bladder neck and posterior urethral contractures, and urorectal fistulation are three well‐recognised complications of the treatment of prostate cancer, whether by surgery or non‐surgical treatment. Because these are relatively rare problems the treatment is uncertain. There is a heavy reliance on endoscopic or instrumental management of urethral strictures and of bladder neck and posterior urethral contractures, and there is little discrimination in any of these conditions between those that are the result of surgery and those that are the result of radiotherapy and other treatment methods using external energy sources. This review aims to clarify out current understanding of these three clinical problems and draws attention to the role of reconstructive surgery, particularly when dealing with bladder neck contractures, prostatic urethral stenoses and urorectal fistula. This also shows that the nature of the problem, the recovery time after treatment and the degree of functional recovery is radically different in the surgical as against the non‐surgical group, to a degree that the authors believe is not sufficiently stressed when patients are counselled and consented before their primary treatment. To review the less common and not widely discussed, but much more serious complications of prostate cancer treatment of: urethral stricture, bladder neck contracture and urorectal fistula. The treatment options for patients with organ‐confirmed prostate cancer include: radical prostatectomy (RP), brachytherapy (BT), external beam radiotherapy (EBRT), high‐intensity focussed ultrasound (HIFU) and cryotherapy; with each method or combination of methods having associated complications. Complications resulting from RP are relatively easy to manage, with rapid recovery and return to normal activities, and usually a return to normal bodily functions. However, after non‐surgical treatments, i.e. BT, EBRT, HIFU and cryotherapy, these same problems are more difficult to treat with a much slower return to a much lower level of function. When counselling patients about the primary treatment of prostate cancer they should be advised that although the same type of complication may occur after surgical or non‐surgical treatment, the scope and scale of that complication, the ease with which it is treated and the degree of restoration of normality after treatment, is altogether in favour of surgery in those for whom surgery is appropriate and who are fit for surgery.