Review Article

Incidence of urethral strictures after radiation therapy Prostate cancer affects approximately 30 % of men and remains the most common cancer with 233,000 new cases projected in 2014 (1). Treatment options for prostate cancer include radical prostatectomy, external beam radiation (EBR), brachytherapy (BT) or a combination of both (2). According to a current report by Jarosek et al. utilizing the Surveillance Epidemiology and End Results (SEER) Medicare linked data from 1992-2007 with follow-up through 2009, 44 % of patients choose EBR, 14 % BT, and 12 % EBR + BT for primary treatment as compared to 27% who elect radical prostatectomy (3). Each treatment modality has a different array of side effects, which can be immediate, medium-, and long-term (2). One of the side effects of radiation therapy is the development of urethral strictures, which occur in 2 % of patients undergoing EBR, 4 % for BT therapy and 11 % of EBR-BT combination therapy (4). Recently, urethral stricture rates of nearly 32 % were reported for patients treated with high-dose BT (5) of which the bulbomembranous part of the urethra is most commonly involved (6,7). Pathology of radiation damage Ionizing radiation has direct effects to tissue such as DNA damage as well as indirect effects such as free radical formation within the cell. In both instances, subsequent cell apoptosis or loss of function will occur. Such tissue damage results in replacement of the native tissue with fibrocytes, which are unable to synthesize collagen (8), an