Therapeutic dilemma of a recurrent urethral stricture and prostate cancer

DOI: 10.2259/magyurol.2018.3.kissz.105

Authors:
Kiss Zoltán dr., Murányi Mihály dr., Flaskó Tibor dr.
Debreceni Egyetem Általános Orvostudományi Kar, Urológiai Tanszék, Debrecen (igazgató: Flaskó Tibor dr.)

Summary

Objective: The authors present a case of a male patient, with recidive urethral stricture of unknown origin, which had an early recurrence of stricture and was diagnosed also with prostate cancer causing therapeutic dilemma to their physicians.
Case report: Urological examination of the 70-year-old male patient due to urinary complaints revealed urethral stricture and elevated PSA. Internal urethrotomy and prostate biopsy was performed, Gleason score 3+3=6 adenocarcinoma was confirmed. The staging examinations revealed organ-localized disease. Meanwhile, recurrent urethral stricture was diagnosed and buccal mucosal graft urethroplasty was performed. Among the therapeutic options, laparoscopic radical prostatectomy was chosen. Three weeks before the planned surgery the patient inserted a silicone tube into the urethra for autoerotic purposes and it could not be removed by the patient. The silicone tube was removed by cystoscope and the surgery was performed. 6 weeks after the operation the PSA was <0.02 ng/ml. They are now reporting about two years of oncologically negative follow-up.
Conclusion: The case demonstrates well that traumatic urethral stricture can be also caused by sexual aberration. Since the prostate cancer was low risk, the authors decided to postpone the operation and the treatment of urethral stricture was performed at first. According to their opinion, radical prostatectomy can also be performed after urethroplasty with adequate functional results.

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