ABSTRACT
BACKGROUND AND PURPOSE: Radiation dose to the bulbomembranous urethra has been shown to correlate with urethral stricture formation. This retrospective case-control study was designed to explore the relationship between dose to the apical/peri-apical regions of the urethra and development of brachytherapy (BXT)-related urethral stricture. MATERIALS AND METHODS: Cases were patients who developed urethral stricture after treatment with BXT as monotherapy and who had urethral dosimetry post-implant. Each case was matched with a control that had not developed urethral stricture. Dosimetry was compared between cases and controls. RESULTS: Twenty-three cases were pair matched with 23 controls. There were no significant differences between the two groups in terms of age, presenting Prostate Specific Antigen (PSA), International Prostate Symptom Score (IPSS) or Gleason score. The dose delivered to the peri-apical and apical urethra was significantly higher for cases when compared with controls (peri-apical urethra: mean V(150) 1.1 Vs 0.8 cc [p=0.02]; apical urethra: mean dose 200 Vs 174 Gy [p=0.01]). The distance from the prostate apex to isodose lines was also found to be significant in predicting stricture formation. CONCLUSION: There was evidence to suggest that the development of BXT-related stricture was associated with radiation dose at the apical and peri-apical urethra. Attention to the dose delivered to those areas may minimise the risk of developing such morbidity.
Subject(s)
Brachytherapy/adverse effects , Prostatic Neoplasms/pathology , Prostatic Neoplasms/radiotherapy , Radiotherapy Planning, Computer-Assisted/methods , Urethra/radiation effects , Urethral Stricture/etiology , Aged , Brachytherapy/methods , Case-Control Studies , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Neoplasm Staging , Prostate-Specific Antigen/blood , Radiation Dosage , Radiometry , Reference Values , Retrospective Studies , Risk Assessment , Treatment Outcome , Urethral Stricture/epidemiology , Urethral Stricture/pathologyABSTRACT
OBJECTIVE: ⢠To describe the incidence of the development of male genital lichen sclerosus (LS) in non-genital skin grafts used in penile reconstruction after cancer surgery. PATIENTS AND METHODS: ⢠Between 1997 and 2009, 177 patients received surgical treatment for penile cancer in the Urology Department at Sunderland Royal Hospital, the regional penile cancer centre for the north-east of England. ⢠Patients who had organ-sparing surgery and non-genital penile graft reconstructions were identified. ⢠Histology reports for specimens obtained from those grafts were reviewed to identify the presence of male genital LS and the incidence of recurrence of squamous cell carcinoma (SCC). RESULTS: ⢠The mean (range) age of patients at diagnosis was 61.8 (32-89) years. Of the 177 patients, 139 had SCC, 32 had carcinoma in situ and six had verrucous carcinoma. ⢠In total, 56 penile reconstructive procedures were performed using split-thickness skin grafts obtained from the inner thigh. ⢠From those grafts, 18 specimens were obtained later for cosmetic, diagnostic or curative purposes. ⢠Male genital LS was found in six of the 18 specimens, and one of them was associated with recurrent verrucous carcinoma. CONCLUSIONS: ⢠This is the first published series to describe the incidence of male genital LS in penile skin grafts taken from a remote site after penile cancer surgery. ⢠These results represent new information that might help explain the aetiology of male genital LS.
