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Devastated bladder outlet in pelvic cancer survivors : issues on surgical reconstruction and quality of life

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Abstract
Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1-8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased oncological cure rates, these adverse events do occur, compromising patients' quality of life. Non-traumatic obstruction of the posterior urethra and bladder neck include membranous and prostatic urethral stenosis and bladder neck stenosis (also known as contracture). The devastated bladder outlet can result from benign conditions, such as neurogenic dysfunction, trauma, iatrogenic causes, or more frequently from complications of oncologic treatment, such as prostate, bladder and rectum. Most posterior urethral stenoses may respond to endoluminal treatments such as dilatation, direct vision internal urethrotomy, and occasionally urethral stents. Although surgical reconstruction offers the best chance of durable success, these reconstructive options are fraught with severe complications and, therefore, are far from being ideal. In patients with prior RT, failed reconstruction, densely fibrotic and/or necrotic and calcified posterior urethra, refractory incontinence or severe comorbidities, reconstruction may not be either feasible or recommended. In these cases, urinary diversion with or without cystectomy is usually required. This review aims to discuss the diagnostic evaluation and treatment options for patients with bladder outlet obstruction with a special emphasis on patients unsuitable for reconstruction of the posterior urethra and requiring urinary diversion.
Keywords
General Medicine, reconstruction, adverse effects, radical prostatectomy, radiation therapy, prostate cancer, vesicourethral anastomotic stenosis, bladder neck contracture, posterior urethral stenosis, devastated bladder outlet

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MLA
Martins, Francisco E., et al. “Devastated Bladder Outlet in Pelvic Cancer Survivors : Issues on Surgical Reconstruction and Quality of Life.” JOURNAL OF CLINICAL MEDICINE, vol. 10, no. 21, MDPI AG, 2021, doi:10.3390/jcm10214920.
APA
Martins, F. E., Holm, H. V., & Lumen, N. (2021). Devastated bladder outlet in pelvic cancer survivors : issues on surgical reconstruction and quality of life. JOURNAL OF CLINICAL MEDICINE, 10(21). https://doi.org/10.3390/jcm10214920
Chicago author-date
Martins, Francisco E., Henriette Veiby Holm, and Nicolaas Lumen. 2021. “Devastated Bladder Outlet in Pelvic Cancer Survivors : Issues on Surgical Reconstruction and Quality of Life.” JOURNAL OF CLINICAL MEDICINE 10 (21). https://doi.org/10.3390/jcm10214920.
Chicago author-date (all authors)
Martins, Francisco E., Henriette Veiby Holm, and Nicolaas Lumen. 2021. “Devastated Bladder Outlet in Pelvic Cancer Survivors : Issues on Surgical Reconstruction and Quality of Life.” JOURNAL OF CLINICAL MEDICINE 10 (21). doi:10.3390/jcm10214920.
Vancouver
1.
Martins FE, Holm HV, Lumen N. Devastated bladder outlet in pelvic cancer survivors : issues on surgical reconstruction and quality of life. JOURNAL OF CLINICAL MEDICINE. 2021;10(21).
IEEE
[1]
F. E. Martins, H. V. Holm, and N. Lumen, “Devastated bladder outlet in pelvic cancer survivors : issues on surgical reconstruction and quality of life,” JOURNAL OF CLINICAL MEDICINE, vol. 10, no. 21, 2021.
@article{01GQFRSSEEYQPX3G463442GWPA,
  abstract     = {{Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1-8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased oncological cure rates, these adverse events do occur, compromising patients' quality of life. Non-traumatic obstruction of the posterior urethra and bladder neck include membranous and prostatic urethral stenosis and bladder neck stenosis (also known as contracture). The devastated bladder outlet can result from benign conditions, such as neurogenic dysfunction, trauma, iatrogenic causes, or more frequently from complications of oncologic treatment, such as prostate, bladder and rectum. Most posterior urethral stenoses may respond to endoluminal treatments such as dilatation, direct vision internal urethrotomy, and occasionally urethral stents. Although surgical reconstruction offers the best chance of durable success, these reconstructive options are fraught with severe complications and, therefore, are far from being ideal. In patients with prior RT, failed reconstruction, densely fibrotic and/or necrotic and calcified posterior urethra, refractory incontinence or severe comorbidities, reconstruction may not be either feasible or recommended. In these cases, urinary diversion with or without cystectomy is usually required. This review aims to discuss the diagnostic evaluation and treatment options for patients with bladder outlet obstruction with a special emphasis on patients unsuitable for reconstruction of the posterior urethra and requiring urinary diversion.}},
  articleno    = {{4920}},
  author       = {{Martins, Francisco E. and Holm, Henriette Veiby and Lumen, Nicolaas}},
  issn         = {{2077-0383}},
  journal      = {{JOURNAL OF CLINICAL MEDICINE}},
  keywords     = {{General Medicine,reconstruction,adverse effects,radical prostatectomy,radiation therapy,prostate cancer,vesicourethral anastomotic stenosis,bladder neck contracture,posterior urethral stenosis,devastated bladder outlet}},
  language     = {{eng}},
  number       = {{21}},
  pages        = {{18}},
  publisher    = {{MDPI AG}},
  title        = {{Devastated bladder outlet in pelvic cancer survivors : issues on surgical reconstruction and quality of life}},
  url          = {{http://doi.org/10.3390/jcm10214920}},
  volume       = {{10}},
  year         = {{2021}},
}

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