Radiation-Induced Urethral Strictures in Males: Diagnostic Approach and Management

Diagnostic Approach

Urethral stricture should be suspected in men with decreased urinary stream, incomplete emptying, dysuria, urinary tract infections, or rising post-void residual following radiation therapy, as recommended by the American Urological Association 1, 2
Definitive diagnosis requires one of the following: Urethro-cystoscopy, Retrograde urethrography (RUG), Voiding cystourethrography (VCUG), or Ultrasound urethrography, with a strength of evidence level of high 1, 3, 4

Treatment selection depends on stricture characteristics, particularly length and location, with the European Association of Urology recommending urethral dilation or direct visual internal urethrotomy (DVIU) for short bulbomembranous strictures (<2 cm) and urethroplasty for longer strictures (≥2 cm), with success rates of 35-70% and 73-90%, respectively 5