Contemporary management of radiation-associated posterior urethral stenosis: a narrative review.

BACKGROUND AND

OBJECTIVE

Radiation-associated posterior urethral stenosis is a challenging entity to treat due to the complex anatomic location and post-radiation tissue compromise. This narrative review examines available data regarding treatment options for posterior urethral stenosis in the radiated patient population. We highlight recent advancements in surgical technique and offer the authors' opinion on an effective management approach.

METHODS

We reviewed English language articles from 2000 to 2025 in the PubMed, Web of Science, and CINAHL databases.

KEY CONTENT AND FINDINGS: It is crucial to assess functional bladder health prior to reconstruction as patients with a history of radiotherapy may demonstrate poor capacity, poor compliance, and/or refractory cystitis. Endoscopic management options are typically pursued first but are associated with high rates of reoperation in this population. A new endoscopic technique involving mucosal incision and reapproximation offers theoretical improvements over traditional incision and dilation. Abdominal and perineal approaches may be effective in refractory cases and recent data describing the use of buccal mucosal grafts in this radiated population is promising. Robot-assisted reconstruction for radiation-associated posterior urethral stenosis is associated with high rates of perineal counter-incision and subsequent reoperation.

CONCLUSIONS

Management of radiation-associated posterior urethral stenosis remains challenging and is associated with significant rates of revision and de novo incontinence. Emerging techniques, including transurethral incision and transverse mucosal realignment, substitution urethroplasty with buccal mucosal graft, and robot-assisted posterior urethral reconstruction, may improve surgical outcomes but will require confirmatory data.