Urethral dilation after radiation

[LiveLongAndPropser]

Reaching out to those who have had urethral dilation.

I completed SBRT in Sept 2023. I've had some minor incontinence issues on and off since before radiation with BPH being blamed. I've been using Tamsulosin for years and it helps prevent straining, but unfortunately I still have issues with fully emptying. I had somewhat hoped (though never promised) that my prostate would have shrunk enough with radiation to help resolve these issues, but it hasn't. I'm seeing a new urologist who is recommending urethral dilation. In reading medical literature, it sounds like this temporarily helps for a few years, but would likely need to be done again. Recovery doesn't sound pleasant. Anyone have success? If so, what was your experience?

[Beatles64]

I would not. Better to undergo a urethroplasty surgery. Dilation could leave you with scar tissue in the urethra, which will make things worse. That was my experience. Had the surgery then a few months later had a AUS device implanted that stopped my incontinence. Have had the device now for 6 years. It’s been a life changer.

[LiveLongAndPropser]

So, to follow up, I have not chosen to do any physical treatment and I am continuing with Flomax/Tamsulosin. It's not my preferred route, but it works for the most part. I have some days that are worse than others, but fortunately, those are not the norm. I have another consult at a different health system for a second opinion, but it is a few months out. I'll see what options they recommend, and I'll ask about the urethroplasty, as well as what else is currently available.

[Seasid]

After **SBRT (stereotactic body radiation therapy)** for prostate cancer, urinary symptoms like difficulty emptying the bladder or incontinence can sometimes persist or worsen due to radiation-induced changes (e.g., inflammation, scarring, or bladder neck/prostate shrinkage). Here’s a breakdown of potential next steps and considerations for your situation:

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### **1. Urethral Dilation After Radiation: Pros and Cons**

- **What it involves**: Mechanical stretching of the urethra to relieve strictures (narrowing) or bladder neck contractures.

- **Pros**:

- May temporarily improve urine flow if a stricture is present.

- Minimally invasive (done under local or general anesthesia).

- **Cons**:

- **High recurrence risk**: Strictures often return within months to years, especially in irradiated tissue (radiation increases scarring risk).

- **Complications**: Pain, bleeding, infection, or worsening scar tissue (as you experienced previously).

- **Limited long-term benefit**: Often a "band-aid" solution unless combined with other treatments.

**Your concerns are valid**—many patients report only short-term relief, and radiation can make tissues more prone to re-stenosis. If your urologist recommends dilation, ask:

- Is there a visible stricture on imaging/cystoscopy?

- Could a **urethral stent** or **permanent catheter** be safer/more effective?

- Are you a candidate for **urethroplasty** (surgical reconstruction), which has better long-term success for strictures but is more invasive?

---

### **2. Alternatives to Dilation After Radiation**

#### **A. Medications**

- **Add a second alpha-blocker** (e.g., silodosin) or **5-alpha reductase inhibitor** (e.g., finasteride) to Flomax for better BPH symptom control.

- **Anticholinergics** (e.g., oxybutynin) or **beta-3 agonists** (e.g., mirabegron) if urge incontinence is an issue.

#### **B. Minimally Invasive Procedures**

- **Rezum or Urolift**: Less effective post-radiation but may still help if residual prostate tissue blocks flow.

- **Transurethral Incision of the Bladder Neck (TUIBN)**: Relaxes the bladder neck without removing tissue (lower risk than TURP post-radiation).

- **Laser Vaporization (GreenLight or ThuLEP)**: Removes obstructive tissue but carries higher risks (e.g., incontinence, strictures) in irradiated patients.

#### **C. Surgical Options**

- **Urethroplasty**: Gold standard for recurrent strictures; success rates are ~85-90% long-term but requires expertise.

- **Artificial Urinary Sphincter (AUS)**: If incontinence is the main issue (as in your prior success story).

- **Urinary Diversion**: Rarely, a last-resort option (e.g., suprapubic catheter).

#### **D. Advanced Diagnostics**

- **Urodynamic testing**: Identifies whether incontinence is due to poor bladder contraction, obstruction, or sphincter weakness.

- **Cystoscopy/MRI urethrogram**: Confirms stricture location/severity to guide treatment.

---

### **3. Key Questions for Your Urologist**

1. Is there a visible **stricture or bladder neck contracture** causing my symptoms?

2. Could my incontinence be **overflow** (from retention) vs. **stress/urge**?

3. Are there **radiation-specific risks** with dilation (e.g., tissue fragility)?

4. Would a **combination approach** (e.g., dilation + intermittent self-catheterization) reduce recurrence?

5. Am I a candidate for **urethroplasty or AUS** given my history?

---

### **Final Thoughts**

Given your prior negative experience with dilation leading to scarring and eventual urethroplasty/AUS success, proceed cautiously. Radiation complicates healing, so **stricture recurrence risk is high** with dilation alone. A **second opinion** from a **reconstructive urologist** (specializing in urethral/stricture care) is critical—they can weigh options like:

- **Urethroplasty** (if strictures are confirmed).

- **AUS revision** (if incontinence worsens).

- Newer therapies like **steroid injections** during dilation to reduce scarring.

Stay proactive—your history shows you’ve navigated complex decisions before. Advocate for tailored, evidence-based care.

DeepSeek said

[LiveLongAndPropser in reply to Seasid]

Thanks so much for the very thorough info. I did choose the new urologist based on their expertise in urethroplasty, unfortunately, this person is out-of-state (I'm sure there are great specialists nearby, but I personally know this one's success). I will bring up TUIBN. I had been a candidate for TURP prior to radiation, but they won't consider it now. I also have heard about a newer drug used in conjunction with urethral dilation called Optilume/paclitaxel that inhibits scar formation at the point of the stricture. Outcomes are decent >70% success from recurring treatment at 5 years. But I'm still concerned it could be a band aid at 54 years old. Appreciate the info!

[Seasid]

What do you mean under recurring treatment?

(I am Hungarian and English is my fourth language.)

I also had sbrt 38 Gy here in Sydney Darlinghurst at Genesis cancer care Elekta Unity Swedish high precision MRI Linac machine and I am more than two years after the SBRT radiation. I am very interested in a side effects and what could we do about it. I was and I am still under firmagon injections.

If I were you I would rather be under degarelix (the fountain of eternal youth) during the SBRT irradiation and then stop it later and your testosterone would renounce quickly.

Now it is too late.

My SBRT specialist said that for clinical trials they are not using a high precision MRI Linac Elekta Unity machine. We had a clinical trial SBRT irradiation plus Nubeqa in Australia sponsored by Bayern. Ot that trial would not be for you because your nmpc wasn't nmCRPC.

Did you have a PSMA pet scan before the SBRT radiation?

What I learnt from that Nubeqa plus SBRT clinical trial description for nmCRPC was that despite the need not to have on the nuclear medicine bone scan or CT a visible metastasis in 70% of eligible candidates you could find visible metastasis on the PSMA pet scan and than you could have sbrt radiation to these sites. Hope I am not confusing you.

[LiveLongAndPropser in reply to Seasid]

Ah, thanks for the clarification. I forget that this is a global community sometimes, my apologies.

The "recurring treatment" means that the urethral dilation procedure was not performed again for more than 70% of men who had the urethral dilation using the Optilume/paclitaxel drug to prevent scarring. The urethral dilation often has to be done again, or another treatment is done to restore the flow of urine.

The "recurring" statement wasn't meant for SBRT or for ADT.

I completed radiation treatment in September of 2023 and did not have ADT after as part of a randomized study (GUIDANCE research study). I did not have a PSMA PET scan before treatment, but I did have an MRI. Because I was diagnosed during COVID, things moved slowly. My tumor had grown 5mm and was close to moving outside the prostate.

I hope that helps clear my statement. I probably should have posted this in urology boards instead of prostate, but I assume some men may have had similar situation.

[Seasid in reply to LiveLongAndPropser]

Your post belong here.

It is related to the radiation treatment therefore prostate cancer.

[Seasid in reply to Seasid]

My RO want that I report to him the side effects of the SBRT treatment and was planning to see me for up to 5 years after the SBRT radiation.

For how long do they want to see you in order to get a feedback from you about a side effects of your SBRT treatment? I believe that the radiation oncologist should be able to recommend you a proper urologists with whom he is working together on people like us after the SBRT radiation.