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SIU/ICUD Consultation on Urethral 
Strictures: Posterior Urethral 
Stenosis After 
Treatment of Prostate Cancer 
Sender He...
Introducción 
• El cáncer de próstata afecta a 217,730 
hombres anualmente. 
• Promedio de edad al diagnóstico es 68 años....
• Uretra es susceptible de sufrir algún daño 
producto de la terapia. 
• Estenosis de la uretra posterior: retención 
urin...
Materiales y Métodos 
• Estudios realizados 
en los últimos 15 
años, revistas, 
resúmenes de 
reuniones científicas, 
pub...
Estenosis de uretra posterior (PUS) 
• Estenosis de: (obliteración) 
• Cuello de vejiga, 
• Anastomosis vesicouretral 
• U...
Epidemiología y Factores de Riesgo 
Prostatectomía Radical 
• Estrechamiento de la anastomosis entre el cuello 
de la veji...
Factores de Riesgo 
• Pérdida excesiva de sangre, tipo de disección 
del cuello de la vejiga, pérdida urinaria 
postoperat...
Radioterapia 
• Radioterapia de haz externo/ Braquiterapia 
• Corta/larga vida media 
• Los efectos adversos tales como PU...
Braquiterapia 
• Estenosis uretral 
complicación más 
frecuente. 
• 0% -14% (4-9% a 5 años) 
• La tasa ha sido 
ligerament...
• 2 años post BT, 30% de los pacientes con dg de 
estenosis uretral y 10% de ellos en solicitud de 
procedimiento, el más ...
• Los factores de riesgo para la estenosis de la 
uretra después de BT incluyen la edad 
avanzada, la raza no blanca, bajo...
• Pacientes con RTU previa, en tto con BT o RT 
de haz externo, 15% de probabilidad de 
desarrollar una estenosis uretral....
Crioterapia 
• Ablación de tejido por 
inducción local de las 
temperaturas 
extremadamente bajas. 
• Tratamiento mínimame...
• Mecanismo de la 
citotoxicidad: necrosis 
coagulativa. 
• Avances: - Utilización de 
ultrasonido 
- Dispositivo de 
cale...
Ultrasonido de alta intensidad 
• Nueva tecnología, se 
piensa que a futuro 
disminuirá incidencia 
de estenosis uretral. ...
• Efecto adverso: obstrucción de la salida de la 
vejiga por edema y desprendimiento de tejido 
necrótico. (25%) 
• RTUP c...
Post-prostatectomía transuretral 
• Relacionada con el tipo de procedimiento 
(quirúrgico, endoscópico o ablativo), tamaño...
Estenosis uretral en cancer de prostata
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Estenosis uretral en cancer de prostata

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estenosis uretral posterior luego de tratamiento de cancer de prostata

Publicado en: Salud y medicina
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Estenosis uretral en cancer de prostata

  1. 1. SIU/ICUD Consultation on Urethral Strictures: Posterior Urethral Stenosis After Treatment of Prostate Cancer Sender Herschorn, Sean Elliott, Michael Coburn, Hunter Wessells, and Leonard Zinman UROLOGY 83: S59eS70, 2014. Interna: Maite Azócar Agosto 2014
  2. 2. Introducción • El cáncer de próstata afecta a 217,730 hombres anualmente. • Promedio de edad al diagnóstico es 68 años. • Sobrevida relativa a 5 años: 99.1%. • 1 de 6 hombres con dg de CaP morirá por esta enfermedad. • Tratamientos: Prostatectomía radical, radioterapia externa, braquiterapia, RT+BT, crioterapia y ablación térmica.
  3. 3. • Uretra es susceptible de sufrir algún daño producto de la terapia. • Estenosis de la uretra posterior: retención urinaria, disuria, poliaquiuria e incontinencia, disminución calidad de vida.
  4. 4. Materiales y Métodos • Estudios realizados en los últimos 15 años, revistas, resúmenes de reuniones científicas, publicaciones por búsqueda manual y electrónica. • Términos de búsqueda: “prostate cancer”, “radical prostatectomy”, “radiation, brachytherapy”, “cryotherapy” y “high-intensity focused ultrasound (HIFU).”
  5. 5. Estenosis de uretra posterior (PUS) • Estenosis de: (obliteración) • Cuello de vejiga, • Anastomosis vesicouretral • Uretra prostática • Uretra membranosa, • Uretra bulbomembranosa.
  6. 6. Epidemiología y Factores de Riesgo Prostatectomía Radical • Estrechamiento de la anastomosis entre el cuello de la vejiga y la uretra membranosa, ("contractura del cuello vesical" (BNC)). • 1,4% -29% de los pacientes PR. • La mayoría de BNC se produce dentro de los 2 años post cirugía. • Mecanismos: tensión de anastomosis, inflamación, extravasación urinaria, mala manipulación de tejidos e isquemia.
  7. 7. Factores de Riesgo • Pérdida excesiva de sangre, tipo de disección del cuello de la vejiga, pérdida urinaria postoperatoria, radioterapia adyuvante (RT), resección transuretral previa de la de próstata (RTU), tabaquismo actual, la edad avanzada, la obesidad, experiencia del cirujano.
  8. 8. Radioterapia • Radioterapia de haz externo/ Braquiterapia • Corta/larga vida media • Los efectos adversos tales como PUS son secundarios a fibrosis crónica y endarteritis progresiva por submucosa pobremente oxigenada y tejidos musculares, con eventual cicatrización de los tejidos. • Daño acumulativo -larga sobrevida de los pacientes.
  9. 9. Braquiterapia • Estenosis uretral complicación más frecuente. • 0% -14% (4-9% a 5 años) • La tasa ha sido ligeramente mayor cuando se combina con radioterapia externa. • Reporte según síntomas-subestimar Nº Radioterapia • 1% -13% • Con seguimiento largo plazo : <7% con <5 años de seguimiento, • 10% -18% con 5-10 años de seguimiento. • Mayor riesgo en pac con RTU previa RT • Incidencia post RT adyuvante o de rescate 3% -8,5%
  10. 10. • 2 años post BT, 30% de los pacientes con dg de estenosis uretral y 10% de ellos en solicitud de procedimiento, el más frecuente dilatación. • Sullivan et al, la ubicación estenosis fue la uretra Bulbomembranosa en 92,1% • Merrick et al, 29 de 1186 pacientes desarrollaron estenosis uretral, y todos estaban en la uretra Bulbomembranosa.
  11. 11. • Los factores de riesgo para la estenosis de la uretra después de BT incluyen la edad avanzada, la raza no blanca, bajos ingresos, más comorbilidades, tratamiento combinado con radioterapia externa o la terapia hormonal, y una historia de la RTUP anterior.
  12. 12. • Pacientes con RTU previa, en tto con BT o RT de haz externo, 15% de probabilidad de desarrollar una estenosis uretral. Significativamente mayor (6%) que sin RTU. • Hipertensión arterial (aumenta toxicidad severa tardía), especialmente si está asociado a DM2. • Tto patología cardiovascular previo BT
  13. 13. Crioterapia • Ablación de tejido por inducción local de las temperaturas extremadamente bajas. • Tratamiento mínimamente invasivo con baja morbilidad, pérdida mínima de sangre, una estancia corta en el hospital, y las altas tasas de biopsia negativa.
  14. 14. • Mecanismo de la citotoxicidad: necrosis coagulativa. • Avances: - Utilización de ultrasonido - Dispositivo de calentamiento uretral • Desprendimiento de tejidos ha sido reportado en 3,8% -23% de los casos. (Reciente 0%) • Fístula rectouretral ha informado que se produzca en 0% -3% de los pacientes.
  15. 15. Ultrasonido de alta intensidad • Nueva tecnología, se piensa que a futuro disminuirá incidencia de estenosis uretral. • 7% y el 30% tratamiento de primera línea y en el 20% de los sometidos a HIFU de rescate. Haz de ultrasonido de alta energía, que se centra en la próstata a través de ecografía transrectal, (100 º C),  necrosis coagulativa inmediata.
  16. 16. • Efecto adverso: obstrucción de la salida de la vejiga por edema y desprendimiento de tejido necrótico. (25%) • RTUP combinado y HIFU en 1 sesión redujo el tiempo de sondaje a 7 días, disminución en la tasa de obstrucción del tracto urinario, de 2% a 8%.
  17. 17. Post-prostatectomía transuretral • Relacionada con el tipo de procedimiento (quirúrgico, endoscópico o ablativo), tamaño de la próstata (pequeñas), extravasación de orina, duración de cateterización, cirugía previa. • 1995  15%; 2004  3.4%

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