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Li KD, Jones CP, Hakam N, Erickson BA, Vanni AJ, Chancellor MB, Breyer BN. Haemorrhagic cystitis: a review of management strategies and emerging treatments. BJU Int 2023; 132:631-637. [PMID: 37501638 DOI: 10.1111/bju.16140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Haemorrhagic cystitis (HC) is characterised by persistent haematuria and lower urinary tract symptoms following radiotherapy or chemotherapy. Its pathogenesis is poorly understood but thought to be related to acrolein toxicity following chemotherapy or fibrosis/vascular remodelling after radiotherapy. There is no standard of care for patients with HC, although existing strategies including fulguration, hyperbaric oxygen therapy, botulinum toxin A, and other intravesical therapies have demonstrated short-term efficacy in cohort studies. Novel agents including liposomal tacrolimus are promising targets for further research. This review summarises the incidence and pathogenesis of HC as well as current evidence supporting its different management strategies.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Charles P Jones
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | | | - Alex J Vanni
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Michael B Chancellor
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oaks, MI, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Ozawa Y, Yagi Y, Nakamura K, Hattori S, Nishiyama T, Momma T, Yorozu A, Saito S. Secondary bladder cancer during long-term follow-up after iodine-125 permanent seed implantation for localized prostate cancer. Brachytherapy 2022; 21:451-459. [DOI: 10.1016/j.brachy.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/02/2022]
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Makino K, Sato Y, Takenaka R, Yamashita H, Akiyama Y, Yamada Y, Nakamura M, Kawai T, Yamada D, Suzuki M, Kume H. Cumulative Incidence and Clinical Risk Factors of Radiation Cystitis after Radiotherapy for Prostate Cancer. Urol Int 2022; 107:440-446. [PMID: 35290980 DOI: 10.1159/000521723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to evaluate the cumulative incidence of overall and severe radiation cystitis following external beam radiation therapy for prostate cancer and investigate the clinical factors predictive of radiation cystitis. METHODS This retrospective study comprised 246 patients who received external beam radiation therapy for localized or locally advanced prostate cancer between 2013 and 2016 in our institution. Of these, 189 received primary radiation therapy and 57 received adjuvant/salvage radiation therapy. Radiation cystitis was recorded using the Common Terminology Criteria for Adverse Events version 5.0 definition, and severe radiation cystitis was defined as grade 3 or higher. All medical records were reviewed to calculate the cumulative incidence of radiation cystitis. Univariate and multivariate Cox regression analyses were used to evaluate its association with clinicopathologic features. RESULTS The median follow-up period after radiation therapy was 56 months (range 5-81). The 5-year cumulative incidence of radiation cystitis and severe radiation cystitis was 16.2% and 3.0%, respectively. Multivariate analyses identified radiation therapy in the adjuvant/salvage setting was the sole risk factor associated with the development of radiation cystitis (hazard ratio: 2.75, p = 0.02). CONCLUSIONS Radiation therapy in the post-prostatectomy setting was associated with increased risk of radiation cystitis compared with radiotherapy as the primary treatment.
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Affiliation(s)
- Katsuhiro Makino
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Takenaka
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideomi Yamashita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaki Nakamura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Rourke KF, Welk B, Kodama R, Bailly G, Davies T, Santesso N, Violette PD. Canadian Urological Association guideline on male urethral stricture. Can Urol Assoc J 2020; 14:305-316. [PMID: 33275550 DOI: 10.5489/cuaj.6792] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Urethral stricture is fundamentally a fibrosis of the urethral epithelial and associated corpus spongiosum, which in turn, causes obstruction of the urethral lumen. Patients with urethral stricture most commonly present with lower urinary tract symptoms, urinary retention or urinary tract infection but may also experience a broad spectrum of other signs and symptoms, including genitourinary pain, hematuria, abscess, ejaculatory dysfunction, or renal failure. When urethral stricture is initially suspected based on clinical assessment, cystoscopy is suggested as the modality that most accurately establishes the diagnosis. This recommendation is based on several factors, including the accuracy of cystoscopy, as well as its wide availability, lesser overall cost, and comfort of urologists with this technique. When recurrent urethral stricture is suspected, we suggest performing retrograde urethrography to further stage the length and location of the stricture or referring the patient to a physician with expertise in reconstructive urology. Ultimately, the treatment decision depends on several factors, including the type and acuity of patient symptoms, the presence of complications, prior interventions, and the overall impact of the urethral stricture on the patient's quality of life. Endoscopic treatment, either as dilation or internal urethrotomy, is suggested rather than urethroplasty for the initial treatment of urethral stricture. This recommendation applies to men with undifferentiated urethral stricture and does not apply to trauma-related urethral injuries, penile urethral strictures (hypospadias, lichen sclerosus), or suspected urethral malignancy. In the setting of recurrent urethral stricture, urethroplasty is suggested rather than repeat endoscopic management but this may vary depending on patient preference and impact of the symptoms on the patient.The purpose of this guideline is to provide a practical summary outlining the diagnosis and treatment of urethral stricture in the Canadian setting.
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Affiliation(s)
- Keith F Rourke
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Blayne Welk
- Division of Urology, Western University, London, ON, Canada
| | - Ron Kodama
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Tim Davies
- McMaster University, Hamilton, ON, Canada
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Pepin A, Aghdam N, Shah S, Kataria S, Tsou H, Datta S, Danner M, Ayoob M, Yung T, Lei S, Gurka M, Collins BT, Krishnan P, Suy S, Hankins R, Lynch JH, Collins SP. Urinary Morbidity in Men Treated With Stereotactic Body Radiation Therapy (SBRT) for Localized Prostate Cancer Following Transurethral Resection of the Prostate (TURP). Front Oncol 2020; 10:555. [PMID: 32432033 PMCID: PMC7214538 DOI: 10.3389/fonc.2020.00555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Clinical data suggest that stereotactic body radiation therapy (SBRT) provides similar clinical outcomes as other radiation modalities for prostate cancer. However, data reporting on the safety of SBRT after TURP is limited. Herein, we report our experience using SBRT to deliver hypofractionated radiotherapy in patients with a history of TURP including physician-reported toxicities and patient-reported quality of life. Methods: Forty-seven patients treated with SBRT from 2007 to 2016 at Georgetown University Hospital for localized prostate carcinoma with a history of prior TURP were included in this retrospective analysis. Treatment was delivered using the CyberKnife® (Accuray Incorporated, Sunnyvale, CA) with doses of 35 Gy or 36.25 Gy in 5 fractions without prostatic urethral sparing. Toxicities were recorded and scored using the CTCAE v.4. Cystoscopy findings were retrospectively reviewed. Urinary quality of life data was assessed using the International Prostate Symptom Scoring (IPSS) and Expanded Prostate Cancer Index Composite 26 (EPIC-26). A Wilcoxon signed-rank sum test was used to determine if there was a statistically significant increase or decrease in IPSS or EPIC scores between timepoints. Minimally important differences were calculated by obtaining half the standard deviation at time of start of treatment. Results: Forty-seven patients at a median age of 72 years (range 63–84) received SBRT. The mean follow-up was 4.7 years (range 2–10 years). Late Grade 2 and grade 3 urinary toxicity occurred in 23 (48.9%) and 3 (6.4%) men, respectively. There were no Grade 4 or 5 toxicities. Approximately 51% of patients experienced hematuria following treatment. Mean time to hematuria was 10.5 months. Twenty-five cystoscopies were performed during follow-up and the most common finding was hyperemia, varices of the bladder neck/TURP defect, and/or necrotic tissue in the TURP defect. Baseline urinary QOL composite scores were low, but they did not clinically significantly decline in the first 2 years following treatment. Conclusions: In patients with prior TURP, prostate SBRT was well-tolerated. GU toxicity rates were comparable to similar patients treated with conventionally fractionated radiation therapy. Urinary quality of life was poor at baseline, but did not worsen clinically over time. Stricter dosimetric criteria could potentially improve the rate of high-grade late toxicity, but may increase the risk of peri-urethral recurrence.
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Affiliation(s)
- Abigail Pepin
- School of Medicine and Health Sciences, George Washington University, Washington, DC, United States
| | - Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Sarthak Shah
- Columbian College of Arts and Sciences, George Washington University, Washington, DC, United States
| | - Shaan Kataria
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Harry Tsou
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Subhradeep Datta
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Malika Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Marilyn Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Marie Gurka
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Pranay Krishnan
- Department of Radiology, Georgetown University Hospital, Washington, DC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Ryan Hankins
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - John H Lynch
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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Goucher G, Saad F, Lukka H, Kapoor A. Canadian Urological Association Best Practice Report: Diagnosis and management of radiation-induced hemorrhagic cystitis. Can Urol Assoc J 2019; 13:15-23. [PMID: 30721124 PMCID: PMC6363576 DOI: 10.5489/cuaj.5788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- George Goucher
- Department of Surgery (Urology) and Oncology, McMaster University, Hamilton, ON, Canada
| | - Fred Saad
- Department of GU Oncology, l’Université de Montréal, Montreal, QC, Canada
| | - Himu Lukka
- Department of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Department of Surgery (Urology) and Oncology, McMaster University, Hamilton, ON, Canada
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Fernandez Ots A, Browne L, Chin YS, Malouf D, Wong K, Bucci J. The risk of second malignancies after 125I prostate brachytherapy as monotherapy in a single Australian institution. Brachytherapy 2016; 15:752-759. [PMID: 27475483 DOI: 10.1016/j.brachy.2016.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/12/2016] [Accepted: 06/13/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the incidence of second primary cancer (SPC) after 125I brachytherapy (BT) for early prostate cancer in an Australian institution. METHODS AND MATERIALS All the patients in our cohort had a cystoscopy before the implant. Data were prospectively collected on all subsequent SPC diagnoses. Standardized incidence ratios (SIRs) were calculated to compare data with the Australian population. Kaplan-Meier analysis was used to determine the actuarial second malignancy and pelvic malignancy rates and the death from SPC and from any cause. RESULTS A total of 889 patients were followed up for a median of 4.16 (0-13) years with 370 (42%) patients having ≥5 years of followup. Sixty patients subsequently developed an SPC of which 11 were pelvic malignancies. The 5- and 10-year cumulative incidences were 1.3% (95% confidence interval [CI]: 0.6-3) and 3.3% (95% CI: 1-7) for any pelvic malignancy and 1% (95% CI: 0.4-2) and 2.6% (1-6) for bladder cancer, respectively. The SIR was significantly higher than expected for all bladder cancers at 2.9 (95% CI: 1-6) and close to significance (SIR, 3.0; 95% CI: 0.97-7) for bladder cancers within the first 5 years of followup in the subgroup analysis. On multivariate analysis, older age was associated with increased SPC risk and older age and positive smoking status were associated with increased overall mortality, mortality due to SPC, and mortality from second malignancy (p < 0.05). CONCLUSIONS There may be a small increased risk of bladder SPC after prostate BT. A tendency toward a higher risk of bladder SPC after BT was found within the first 5 years of followup probably reflecting screening bias.
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Affiliation(s)
- Ana Fernandez Ots
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia.
| | - Lois Browne
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia
| | - Yaw Sinn Chin
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia
| | | | - Keith Wong
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia
| | - Joseph Bucci
- Radiation Oncology Department, St George Cancer Care Centre, NSW, Australia
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NAKANO TAITO, IZUMI KOUJI, MAOLAKE AERKEN, NATSAGDORJI ARIUNBOLD, IWAMOTO HIROAKI, KITAGAWA YASUHIDE, KADONO YOSHIFUMI, KONAKA HIROYUKI, MIZOKAMI ATSUSHI, NAMIKI MIKIO. Aplastic anemia associated with severe hemorrhagic cystitis following radiotherapy for prostate cancer. Mol Clin Oncol 2016; 4:794-796. [DOI: 10.3892/mco.2016.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/28/2016] [Indexed: 11/06/2022] Open
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Observations and outcomes of urethroplasty for bulbomembranous stenosis after radiation therapy for prostate cancer. World J Urol 2015; 34:377-82. [PMID: 26047655 DOI: 10.1007/s00345-015-1608-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Bulbomembranous stenosis is a significant complication of radiotherapy for prostate cancer. Our purpose is to report outcomes of urethroplasty for radiation-induced bulbomembranous urethral stenoses. METHODS Thirty-five patients underwent urethroplasty for refractory radiation-induced bulbomembranous stenoses from January 2004 to November 2013. Patients had a minimum follow-up of 12 months with routine cystoscopy at 6 and 12 months. Primary outcome was urethral patency, and secondary outcomes were 90-day complications, de novo incontinence, de novo erectile dysfunction and bothersome LUTS. Outcomes were compared using Fisher's exact test. RESULTS Of the 35 patients, 20 and 15 had stenosis related to external beam radiation therapy and brachytherapy, respectively. Mean stricture length was 3.5 cm. Reconstruction was performed using anastomotic urethroplasty in 23 patients (65.7 %), while 12 required tissue transfer as a buccal mucosa graft (20.0 %) or penile island flap (14.3 %). With 50.5 months of follow-up, thirty patients (85.7 %) achieved cystoscopic patency with no significant difference between techniques (p = 0.32). A 90-day complication rate of 31.4 % was observed (all Clavien 1-2) with no difference between techniques (p = 1.00). Adverse change in continence occurred in 25.7 % of patients (13.3 % in those without previous TURP). Postoperatively, persisting storage LUTS occurred in 40.0 and 30.4 % described adverse change in erectile function (exclusively in the anastomotic urethroplasty group). CONCLUSIONS Reconstruction of radiation-induced bulbomembranous stenosis yields satisfying patency rates. However, radiation-induced urethral stenosis is not an isolated problem as many patients suffer from storage symptoms, erectile dysfunction or incontinence as a consequence of treatment either before or after urethroplasty.
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Gurka MK, Chen LN, Bhagat A, Moures R, Kim JS, Yung T, Lei S, Collins BT, Krishnan P, Suy S, Dritschilo A, Lynch JH, Collins SP. Hematuria following stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer. Radiat Oncol 2015; 10:44. [PMID: 25890265 PMCID: PMC4358866 DOI: 10.1186/s13014-015-0351-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/04/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hematuria following prostate radiotherapy is a known toxicity that may adversely affect a patient's quality of life. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT hematuria would be more common than with alternative radiation therapy approaches. Herein, we describe the incidence and severity of hematuria following stereotactic body radiation therapy (SBRT) for prostate cancer at our institution. METHODS Two hundred and eight consecutive patients with prostate cancer treated with SBRT monotherapy with at least three years of follow-up were included in this retrospective analysis. Treatment was delivered using the CyberKnife® (Accuray) to doses of 35-36.25 Gy in 5 fractions. Toxicities were scored using the CTCAE v.4. Hematuria was counted at the highest grade it occurred in the acute and late setting for each patient. Cystoscopy findings were retrospectively reviewed. Univariate and multivariate analyses were performed. Hematuria-associated bother was assessed via the Expanded Prostate Index Composite (EPIC)-26. RESULTS The median age was 69 years with a median prostate volume of 39 cc. With a median follow-up of 48 months, 38 patients (18.3%) experienced at least one episode of hematuria. Median time to hematuria was 13.5 months. In the late period, there were three grade 3 events and five grade 2 events. There were no grade 4 or 5 events. The 3-year actuarial incidence of late hematuria ≥ grade 2 was 2.4%. On univariate analysis, prostate volume (p = 0.022) and history of prior procedure(s) for benign prostatic hypertrophy (BPH) (p = 0.002) were significantly associated with hematuria. On multivariate analysis, history of prior procedure(s) for BPH (p < 0.0001) and α1A antagonist use (p = 0.008) were significantly associated with the development of hematuria. CONCLUSIONS SBRT for prostate cancer was well tolerated with hematuria rates comparable to other radiation modalities. Patients factors associated with BPH, such as larger prostate volume, alpha antagonist usage, and prior history of procedures for BPH are at increased risk for the development of hematuria.
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Affiliation(s)
- Marie K Gurka
- Department of Radiation Oncology, University of Louisville, Louisville, USA.
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
| | - Aditi Bhagat
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
| | - Rudy Moures
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
| | - Joy S Kim
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
| | - Pranay Krishnan
- Department of Radiology, Georgetown University Hospital, Washington, USA.
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
| | - John H Lynch
- Department of Urology, Georgetown University Hospital, Washington, USA.
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA.
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Internal urethrotomy in patients with recurrent urethral stricture after buccal mucosa graft urethroplasty. World J Urol 2014; 33:1337-44. [DOI: 10.1007/s00345-014-1450-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022] Open
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