Recalcitrant posterior urethral stenoses: a narrative review of refractory bladder neck contractures and vesicourethral anastomotic stenoses after treatment for localized prostate cancer

Posterior urethral stenoses, more specifically, bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS), are a troublesome and dreaded complication after treatment for localized prostate cancer. Patients can develop bothersome and recurrent lower urinary tract symptoms (LUTS) and other urinary complications that diminish their quality of life. The diagnosis and management of these patients can be cumbersome and overwhelming to physicians as many require multiple interventions. We reviewed the current literature to better define the incidence of BNC/VUAS after different treatment modalities for localized prostate cancer and to determine the best management strategies. In general, the incidence is higher in radiated patients and takes significantly longer to present, compared to those that are treated with surgery alone. The risk is highest in patients who undergo salvage prostatectomy with an incidence of up to forty percent. A graded approach should be taken to management, as repeated attempts of minimally invasive methods are relatively successful. More aggressive treatment, either endoscopic or surgical, can result in severe de novo stress urinary incontinence (SUI) and require staged placement of an artificial urinary sphincter (AUS) and requires an educated and motivated patient. Robotic assisted laparoscopic (RAL) techniques are increasing in popularity and show promising results with lower rates of incontinence. Urinary diversion should also be considered in the treatment algorithm for these patients as it is sometimes the best option. However, larger, less heterogeneous studies are needed.