Surgical management of posterior urethral stenosis (PUS) following treatment for prostate cancer is one of the most challenging aspects of urethral reconstructive surgery, especially in patients who have undergone multimodal therapies such as radiation therapy and surgical prostatectomy. In the modern era, treatment of prostate cancer often includes surgical extirpation, radiation‐based treatments (external beam or internal application with implanted seeds), or other energy‐based treatments like high‐frequency focused ultrasound or cryotherapy. Additionally, PUS, specifically bladder neck contracture, can result from nononcologic surgery for lower urinary tract symptoms, most commonly transurethral resection of the prostate or other laser surgeries such as holmium laser enucleation. The authors, Yu et al.[
1], mention that endoluminal management is usually the first step for nonobliterative stenoses. A recent meta‐analysis evaluated various endoluminal treatments described in the medical literature, identifying mitomycin‐C as the most successful and best‐studied agent[
2]. More recently, a technical article describing the use of mitomycin‐C injection in PUS demonstrated success in two initial patients[
3]. In this author's experience with this technique, the results of mitomycin‐C injection following urethrotomy have been durable in nonradiated patients. However, patients who receive radiotherapy often develop dystrophic calcification, which is problematic to manage in the long term and does not respond to further resection or injection. Open urethroplasty remains the standard surgical option, but the advent of robotic surgery has introduced a minimally invasive option for management. Following open urethroplasty, patients are typically completely incontinent due to the trans‐sphincteric approach involved in perineal reconstruction. More recently, Sterling and colleagues described a novel technique using a nontransecting perineal approach with augmented anastomosis using a buccal mucosa graft in patients with stenosis following prostatectomy and radiotherapy. This challenging patient group achieved an 85% success rate with no incontinence observed in up to 2 years of follow‐up[
4]. Robotic surgical correction is also an option, showing a greater than 90% success rate in nonradiated patients at approximately 2 years of follow‐up, and a 60% success rate in radiated patients[
5]. With progress in surgical innovation and the application of novel technologies and pharmacotherapeutics, the treatment of PUS continues to evolve, yielding better outcomes and improvements in patient quality of life.
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