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

Introduction

Posterior urethral stenosis (PUS) is a challenging entity to treat and is frequently refractory to initial management attempts. Combined with a history of pelvic radiotherapy (RT), urologists are faced with a particularly vexing disease. Still, in contemporary practice, a number of effective management strategies exist, offering many patients a chance to maintain orthotopic micturition. Other patients will see more improvement in quality of life with urinary diversion. This review will describe and compare contemporary management options for radiation-associated PUS. We present this article in accordance with the Narrative Review reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2025-183/rc).

Methods

We performed a narrative review of available English language literature from January 2000 to January 2025 utilizing the databases PubMed, Web of Science, and CINAHL. The initial literature review was performed with the assistance of a medical librarian from The Talbot Research Library at Fox Chase Cancer Center (Philadelphia, Pennsylvania, United States). All articles were then reviewed for content by authorsS.J.I. and M.L. The initial literature review identified 115 articles and ultimately 73 were examined in full for inclusion in the review. The search strategy summary, including search terms, is available in Table 1.

Findings

Background and etiology

Consistent with terminology set forth by the Société Internationale d'Urologie/International Consultation on Urological Diseases consensus statement on urethral strictures, we will utilize the term “posterior urethral stenosis (PUS)” to refer to narrowing between the membranous urethra and bladder neck (1). As a subcategory, vesicourethral anastomotic stenosis (VUAS) will be used to further specify narrowing in the absence of the prostate. This review will focus on radiation-associated PUS.

Assessment of 6,597 patients from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database revealed an overall PUS incidence of 5.2% in patients with any type of primary management for prostate cancer (2). While modern incidence of VUAS is 1–2.5% (2), adjuvant or salvage RT increases the incidence to 3–10% (3,4). External beam radiation therapy is associated with a 1.5–1.7% PUS rate, brachytherapy a rate of 1.8–1.9%, and combined external beam and brachytherapy a rate of 4.9–5.2% (5,6). With over 777,000 prostate cancer survivors who have undergone radiation therapy currently living in the United States (7) and the typical delayed presentation of radiated PUS by several years (2,6), we anticipate that radiated PUS will continue to be a significant challenge for urologic surgeons.

Oxidative injury from RT reliably damages the endothelium of small vessels, resulting in extracellular fibrosis and local ischemia. In the urinary tract, this can affect the urothelium, creating cracks that allow escape of caustic urine into the surrounding tissue, further exacerbating fibrosis and scar formation (7). Additionally, radiation damage can cause cell cycle arrest of fibroblasts, halting their differentiation and resulting in an overproduction of collagen typical of fibrotic and scarred radiated tissue (8). Surgical efforts at revision are then complicated by this same local ischemia and general tissue compromise.

Workup

Patients with RT-associated PUS may present with symptoms of urinary obstruction and/or urinary incontinence. The diagnosis is typically made cystoscopically. Especially for radiated patients, it is important to confirm urethral patency prior to incontinence surgery as manipulation of PUS after placement of an artificial urinary sphincter may jeopardize the urethral cuff (9).

Prior to undertaking a complex reconstruction, a detailed history is necessary to confirm that bladder function is adequate to justify organ preservation. Patients with poorly compliant, low capacity bladders, significant pelvic pain or dysuria (which should prompt workup for urinary fistula), or those with a significant history of radiation cystitis requiring recurrent intervention are typically unsuitable candidates for orthotopic reconstruction (10). Urodynamic studies may aid the evaluation of complex cases.

Many PUS patients present with a suprapubic tube, but those without one who are dependent upon a urethral catheter or intermittent catheterization should be transitioned to suprapubic tube drainage to allow for urethral rest (11). Additionally, a radiated patient with PUS and prostate in situ whose stenosis precludes adequate visualization of the remaining posterior urethra should receive suprapubic drainage to allow for diagnostic evaluation of the prostatic urethra. Combination voiding cystourethrogram/retrograde urethrogram (Figure 1), magnetic resonance imaging (12), or antegrade cystoscopy can assess proximal patency. Cystoscopy has the added benefit of assessing the tissue health of the bladder neck and prostatic urethra as significant radionecrosis, dystrophic calcification, or fistula may necessitate more complicated reconstruction with subtotal prostatectomy or supravesical urinary diversion (Figure 2). All radiated PUS patients should be counseled regarding the substantial risk of de novo stress urinary incontinence and potential need for additional surgical intervention to address this secondary diagnosis.

Figure 1 Imaging of radiation-associated posterior urethral stenosis. (A) Preoperative retrograde urethrogram. (B) Preoperative voiding cystourethrogram. Note a long segment stenosis and obliterated segment. This information would impact our patient counseling; here orthotopic reconstruction carries a substantial risk of failure and urinary diversion may ultimately provide better functional outcomes.

Figure 2 Authors’ proposed management algorithm. BMG, buccal mucosal graft; TUI TMR, transurethral incision with transverse mucosal realignment; VUAS, vesicourethral anastomotic stenosis.

Management of radiation-associated PUS

Endoscopic techniques

Endoscopic techniques are generally utilized as a first-line, minimally invasive management approach for radiation-associated PUS. These procedures are limited to patients with non-obliterative urethral stenoses. Overall, endoscopic approaches may offer the advantage of reduced morbidity and shorter recovery; however, they are often limited by high recurrence rates and need for repeat interventions (Table 2).

In managing radiation-associated PUS, endoscopic dilation and direct visual internal urethrotomy (DVIU) have been employed with success rates ranging between 51–69% (18-20). Sullivan and colleagues evaluated 38 patients undergoing endoscopic treatment for PUS after brachytherapy for prostate cancer and demonstrated a 51% recurrence-free rate at 16 months median follow up. Furthermore, they found that 10.5% of patients developed de novo stress urinary incontinence (19). In a similar cohort, Merrick and colleagues reported a 69% recurrence-free rate after initial endoscopic treatment for radiation-associated PUS (20). More recently, adjunctive injection of mitomycin C with DVIU has been used in an effort to mitigate recurrent scar formation. In one study of 18 patients with radiation-associated PUS who underwent DVIU with mitomycin C, 67% of patients were recurrence-free at a median follow-up of 25.8 months (18).

Endoscopic techniques have also been utilized for management of VUAS. Success rates for these procedures have varied between 42% and 58% and are clearly lower in the radiated patient population (15). Pfalzgraf and associates reported outcomes of patients who underwent transurethral resection and transurethral incision for management of VUAS. Among the 38 patients in their cohort who had undergone prior radiation therapy, only 16 (42%) patients remained recurrence-free after a single endoscopic treatment and 7 (18%) patients developed de novo incontinence over a median follow-up of 17 months (17).

Similar studies have reported success rates between 42–69% with endoscopic management in patients with radiation-associated PUS (13-17,28,34). However, these studies have also corroborated the relatively low rates of de novo stress incontinence (4–18%), suggesting that while endoscopic approaches may not provide durable long-term outcomes, they carry a lower risk of functional complications compared to more invasive interventions.

Recently, transurethral incision with transverse mucosal realignment has been proposed as a novel endoscopic technique for managing PUS and VUAS (21). Unlike traditional endoscopic approaches that focus solely on incising or dilating the stricture, this technique aims to realign healthy mucosa at the incision site to promote better healing and reduce recurrence. In their study, Warner and colleagues performed an endoscopic mucosal realignment in 19 patients with PUS. At a median follow-up of 6 months, 89% remained stricture-free after a single treatment. Six (32%) patients had a history of pelvic radiation. Notably, no cases of de novo incontinence were reported.

Long-term data is needed to define the utility of this technique in the radiated patient population. In the authors’ experience, shorter stenoses may be effectively managed; however with longer stenoses or significant radionecrosis and tissue compromise (often the case when the prostate is in situ) there may not be sufficient tissue laxity to perform a mucosal realignment. For such patients, we provide realistic counseling of the limitations of endoscopic reconstruction. Confirmation in a multi-center trial will define the reproducibility of this approach and clarify its role in contemporary endoscopic management of radiation-associated PUS.

Abdominal and perineal techniques

Open abdominal and perineal approaches represent a more definitive management strategy for radiation-associated PUS, often providing greater durability compared to endoscopic techniques. However, there may be an increased rate of complications associated with the reconstruction of a radiated posterior urethra, especially stress urinary incontinence (Table 2). Open surgical techniques may be considered primary treatment in select cases or as salvage options for patients with recurrent stenoses following failed endoscopic interventions.

Excision and primary anastomotic (EPA) urethroplasty is historically the most common approach for surgical management of short-segment posterior urethral stenoses. This technique allows for complete removal of the stenotic segment while enabling a tension-free anastomosis, optimizing the likelihood of a successful outcome. In the largest series examining outcomes of EPA in the management of 137 patients with radiation-associated PUS, Voelzke and colleagues reported a success rate of 86.9% at a mean follow-up of 32.3 months (23). A majority of patients in their cohort required adjunctive surgical maneuvers including corporal splitting (71.5%), partial prostatectomy (37.2%), partial pubectomy (12.4%), and utilization of a gracilis muscle flap (23.4%). Postoperatively, stress urinary incontinence of more than one pad per day was observed in 32.1% of patients (23). Another study analyzing a cohort of 116 patients reported a stenosis recurrence rate of 19.0% at a mean follow-up of 8.6 months, increased to 36.6% at 30.7 months. De novo stress incontinence was observed in 10.3% of patients, however, the majority of patients in this cohort had preexisting stress urinary incontinence prior to surgery which may have influenced postoperative continence outcomes (24). Other retrospective studies have demonstrated comparable success rates and complication rates (22,25-27,33) with one systematic review of urethroplasty for radiation-associated PUS estimating overall success at 80% and de novo incontinence at 20%, regardless of urethroplasty technique (37) (Table 2).

Although EPA has historically been the preferred approach for managing radiation-associated PUS, it may carry significant risk of de novo incontinence due to unintended disruption of the external sphincter during scar excision (31). In addition, for those patients who develop de novo incontinence postoperatively and seek continence restoration with an artificial urinary sphincter, they may face a higher risk of device erosion if they have undergone prior urethral transection (38). Lastly, circumferential dissection of the urethra during EPA may theoretically increase ischemia and contribute to stenosis recurrence. Given these heightened risks, recent studies have explored substitution urethroplasty as an alternative management approach (30,32).

A large multi-institutional study explored the use of dorsal onlay buccal mucosa graft urethroplasty in prostate cancer survivors with radiation-associated PUS (29). Their cohort included 79 patients, with 82.3% remaining recurrence-free at a median follow-up of 21 months. Importantly, de novo stress incontinence occurred in only 8.1% of patients and there were no Clavien grade 3 or greater complications. The authors suggested that the dorsal approach may help preserve the external sphincter, allowing for excellent postoperative continence rates and also facilitating graft take, even in areas potentially affected by vascular compromise due to radiation. This represents a contemporary advancement that challenges the previous belief that a radiated field would lead to poor buccal mucosa graft take. Furthermore, dorsal onlay buccal mucosa graft urethroplasty has demonstrated durable urethral patency with relatively low rates of incontinence in patients with VUAS (28) (Figure 3).

Figure 3 Radiation-associated vesicourethral anastomotic stenosis. (A) Preoperative voiding cystourethrogram. (B) Three-week postoperative voiding cystourethrogram after perineal dorsal buccal graft urethroplasty.

Recent work has highlighted the use of the robot-assisted transabdominal approach for managing radiation-associated PUS. Proponents suggest that the robotic platform may offer several advantages, including magnified visualization, improved ergonomics in a confined pelvic space, and the ability to avoid perineal dissection which could disrupt the external urinary sphincter complex and compromise urethral vasculature in a patient population at high risk for future anti-incontinence surgery (35). Nevertheless, data remains limited regarding the utility of robotics in this highly complex patient population.

In one of the largest series to date, Shakir and colleagues reported an 87.5% success rate in 16 patients who underwent robotic transabdominal repair of radiated VUAS at a median follow-up of 12 months (36). Success was defined by passage of a 17 French cystoscope or a peak flow of >15 mL/s on uroflowmetry. On closer review, 43.8% (7/16) of patients required a perineal counterincision which may negate one potential benefit of a robot-assisted, transabdominal approach. The authors were unable to predict which patients would require perineal counterincision, thus making preoperative counseling challenging. Although only two patients developed de novo stress urinary incontinence in this cohort, 40.6% of patients had preoperative stress urinary incontinence.

Other investigations report more modest outcomes of robot-assisted PUS reconstruction in radiated patients. In an honest report delineating sobering outcomes in radiated prostate cancer survivors with PUS, Bearrick and associates reported single center outcomes for robotic reconstruction of PUS (35). Specifically, they evaluated ten PUS patients who underwent prior prostatectomy, five who underwent prior bladder outlet surgery, and five who underwent prior RT. Though anatomic success was 90% and 100% for non-radiated prostatectomy and bladder outlet surgery recipients, success for radiated patients was 60% at a median follow up of 27.6 months. Four out of five radiated patients required re-intervention, and four out of five proceeded to artificial urinary sphincter placement (35). Another small series of 6 patients included 3 patients with RT of which a third required revision surgery (39). Larger studies are needed to further assess the efficacy and functional outcomes of the robotic transabdominal approach for radiation-associated PUS.

Conclusions

Management of radiation-associated PUS is complex. Endoscopic approaches remain first line due to decreased morbidity but demonstrate high recurrence rates. Open surgical approaches have higher success rates with commensurate increase in incontinence risk. New techniques including endoscopic mucosal realignment, dorsal buccal graft urethroplasty, and robot-assisted posterior urethral reconstruction offer potential to improve outcomes in this population, but require confirmatory data. Future research will benefit from prospective, multi-institutional study with long term outcomes, including patient reported outcomes and need for revision surgery or diversion.

Acknowledgments

We would like to thank and acknowledge Andrea Tomlinson, MLIS, Senior Librarian of the Talbot Research Library at Fox Chase Cancer Center for her assistance with the initial literature review.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Translational Andrology and Urology for the series “A Contemporary Approach to Complex Posterior Urethral Reconstruction”. The article has undergone external peer review.

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2025-183/rc

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2025-183/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2025-183/coif). The series “A Contemporary Approach to Complex Posterior Urethral Reconstruction” was commissioned by the editorial office without any funding or sponsorship. S.J.I. and J.S. served as the unpaid guest editors of the series. J.S. serves as an unpaid editorial board member of Translational Andrology and Urology from June 2016 to July 2026. J.S. received consulting fees from Boston Scientific Corporation and Coloplast Corporation. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Latini JM, McAninch JW, Brandes SB, et al. SIU/ICUD Consultation On Urethral Strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology 2014;83:S1-7. [Crossref] [PubMed]
2. Browne BM, Vanni AJ. Management of Urethral Stricture and Bladder Neck Contracture Following Primary and Salvage Treatment of Prostate Cancer. Curr Urol Rep 2017;18:76. [Crossref] [PubMed]
3. Macdonald OK, Lee RJ, Snow G, et al. Prostate-specific antigen control with low-dose adjuvant radiotherapy for high-risk prostate cancer. Urology 2007;69:295-9. [Crossref] [PubMed]
4. Daly T, Hickey BE, Lehman M, et al. Adjuvant radiotherapy following radical prostatectomy for prostate cancer. Cochrane Database Syst Rev 2011;2011:CD007234. [Crossref] [PubMed]
5. Elliott SP, Meng MV, Elkin EP, et al. Incidence of urethral stricture after primary treatment for prostate cancer: data From CaPSURE. J Urol 2007;178:529-34; discussion 534. [Crossref] [PubMed]
6. Awad MA, Gaither TW, Osterberg EC, et al. Prostate cancer radiation and urethral strictures: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2018;21:168-74. [Crossref] [PubMed]
7. Sterling J, Rahman SN, Varghese A, et al. Complications after Prostate Cancer Treatment: Pathophysiology and Repair of Post-Radiation Urethral Stricture Disease. J Clin Med 2023;12:3950. [Crossref] [PubMed]
8. Burger A, Löffler H, Bamberg M, et al. Molecular and cellular basis of radiation fibrosis. Int J Radiat Biol 1998;73:401-8. [Crossref] [PubMed]
9. Ivan SJ, Cohn JA, Loh-Doyle JC, et al. Cuff Conundrums: Best Practice Recommendations for Urethral Instrumentation With an Artificial Urinary Sphincter in Place. J Urol 2025;213:271-3. [Crossref] [PubMed]
10. Moring N, Barrett S, Peterson AC, et al. Pelvic Extirpative Surgery for the "End-Stage Irradiated Bladder". Cancers (Basel) 2023;15:4238. [Crossref] [PubMed]
11. Moncrief T, Gor R, Goldfarb RA, et al. Urethral Rest with Suprapubic Cystostomy for Obliterative or Nearly Obliterative Urethral Strictures: Urethrographic Changes and Implications for Management. J Urol 2018;199:1289-95. [Crossref] [PubMed]
12. Joshi PM, Desai DJ, Shah D, et al. Magnetic resonance imaging procedure for pelvic fracture urethral injuries and recto urethral fistulas: A simplified protocol. Turk J Urol 2021;47:35-42. [Crossref] [PubMed]
13. Sullivan L, Williams SG, Tai KH, et al. Urethral stricture following high dose rate brachytherapy for prostate cancer. Radiother Oncol 2009;91:232-6. [Crossref] [PubMed]
14. Farrell MR, Lawrenz CW, Levine LA. Internal Urethrotomy With Intralesional Mitomycin C: An Effective Option for Endoscopic Management of Recurrent Bulbar and Bulbomembranous Urethral Strictures. Urology 2017;110:223-7. [Crossref] [PubMed]
15. Merrick GS, Butler WM, Wallner KE, et al. Risk factors for the development of prostate brachytherapy related urethral strictures. J Urol 2006;175:1376-80; discussion 1381. [Crossref] [PubMed]
16. Veerman H, Vis AN, Hagens MJ, et al. Surgical and Functional Outcomes of Bladder Neck Incision for Primary Vesico-Urethral Anastomosis Stricture after Robot-assisted Radical Prostatectomy are Influenced by the Presence of Pre- or Postoperative Radiotherapy. Urology 2022;166:216-22. [Crossref] [PubMed]
17. Pfalzgraf D, Worst T, Kranz J, et al. Vesico-urethral anastomotic stenosis following radical prostatectomy: a multi-institutional outcome analysis with a focus on endoscopic approach, surgical sequence, and the impact of radiation therapy. World J Urol 2021;39:89-95. [Crossref] [PubMed]
18. Britton CJ, Sharma V, Fadel AE, et al. Vesicourethral Anastomotic Stenosis Following Radical Prostatectomy: Risk Factors, Natural History, and Treatment Outcomes. J Urol 2023;210:312-22. [Crossref] [PubMed]
19. Elliott SP, McAninch JW, Chi T, et al. Management of severe urethral complications of prostate cancer therapy. J Urol 2006;176:2508-13. [Crossref] [PubMed]
20. Hacker EC, Maganty A, Pere MM, et al. Outcomes of Vesicourethral Anastomotic Stenosis and Bladder Neck Contracture With Direct Visual Internal Urethrotomy With Mitomycin-C After Prostate Cancer Treatment. Urology 2022;165:331-5. [Crossref] [PubMed]
21. Sterling J, Simhan J, Flynn BJ, et al. Multi-Institutional Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Patients With Postprostatectomy, Postradiation Anastomotic Stenosis. J Urol 2024;211:596-604. [Crossref] [PubMed]
22. Rozanski AT, Zhang LT, Holst DD, et al. The Effect of Radiation Therapy on the Efficacy of Internal Urethrotomy With Intralesional Mitomycin C for Recurrent Vesicourethral Anastomotic Stenoses and Bladder Neck Contractures: A Multi-Institutional Experience. Urology 2021;147:294-8. [Crossref] [PubMed]
23. Abramowitz DJ, Balzano FL, Ruel NH, et al. Transurethral Incision with Transverse Mucosal Realignment for the Management of Bladder Neck Contracture and Vesicourethral Anastomotic Stenosis. Urology 2021;152:102-8. [Crossref] [PubMed]
24. Voelzke BB, Leddy LS, Myers JB, et al. Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment. Urology 2021;152:117-22. [Crossref] [PubMed]
25. Keith CG, Davenport MT, Kavoussi M, et al. Long-term outcomes of anastomotic urethroplasty for radiation-induced strictures. World J Urol 2020;38:3055-60. [Crossref] [PubMed]
26. Barnard J, Liaw A, Gelman J. Long-term follow-up suggests high satisfaction rates for bulbomembranous radiation-induced urethral stenoses treated with anastomotic urethroplasty. World J Urol 2023;41:1905-12. [Crossref] [PubMed]
27. Chung PH, Esposito P, Wessells H, et al. Incidence of Stress Urinary Incontinence After Posterior Urethroplasty for Radiation-induced Urethral Strictures. Urology 2018;114:188-92. [Crossref] [PubMed]
28. Fuchs JS, Hofer MD, Sheth KR, et al. Improving Outcomes of Bulbomembranous Urethroplasty for Radiation-induced Urethral Strictures in Post-Urolume Era. Urology 2017;99:240-5. [Crossref] [PubMed]
29. Hofer MD, Gonzalez CM. Management of radiation-induced urethral strictures. Transl Androl Urol 2015;4:66-71. [Crossref] [PubMed]
30. Meeks JJ, Brandes SB, Morey AF, et al. Urethroplasty for radiotherapy induced bulbomembranous strictures: a multi-institutional experience. J Urol 2011;185:1761-5. [Crossref] [PubMed]
31. Sapienza LG, Ning MS, Carvalho EF, et al. Efficacy and Incontinence Rates After Urethroplasty for Radiation-induced Urethral Stenosis: A Systematic Review and Meta-analysis. Urology 2021;152:109-16. [Crossref] [PubMed]
32. Rourke K, Kinnaird A, Zorn J. Observations and outcomes of urethroplasty for bulbomembranous stenosis after radiation therapy for prostate cancer. World J Urol 2016;34:377-82. [Crossref] [PubMed]
33. McGeady JB, McAninch JW, Truesdale MD, et al. Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol 2014;192:1756-61. [Crossref] [PubMed]
34. Vetterlein MW, Kluth LA, Zumstein V, et al. Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM). World J Urol 2020;38:2863-72. [Crossref] [PubMed]
35. Glass AS, McAninch JW, Zaid UB, et al. Urethroplasty after radiation therapy for prostate cancer. Urology 2012;79:1402-5. [Crossref] [PubMed]
36. Policastro CG, Simhan J, Martins FE, et al. A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis. World J Urol 2021;39:2669-75. [Crossref] [PubMed]
37. Bearrick EN, Findlay BL, Maciejko LA, et al. Robotic Urethral Reconstruction Outcomes in Men With Posterior Urethral Stenosis. Urology 2022;161:118-24. [Crossref] [PubMed]
38. Shakir NA, Alsikafi NF, Buesser JF, et al. Durable Treatment of Refractory Vesicourethral Anastomotic Stenosis via Robotic-assisted Reconstruction: A Trauma and Urologic Reconstructive Network of Surgeons Study. Eur Urol 2022;81:176-83. [Crossref] [PubMed]
39. Lavollé A, de la Taille A, Chahwan C, et al. Extraperitoneal Robot-Assisted Vesicourethral Reconstruction to Manage Anastomotic Stricture Following Radical Prostatectomy. Urology 2019;133:129-34. [Crossref] [PubMed]