Dr. Sean Elliott, MD
Reconstructive Urologist
Dilation
One way to treat prostate cancer is radical prostatectomy which means removal of the entire prostate gland.
prostate
urethra
bladder
rectum
Because the urethra runs through the middle of the prostate and is connected to it, about 1-2 inches of urethra is removed when the prostate is removed.
prostate
bladder
urethra
The bladder is pulled down and then the urethra and “neck” of the bladder are sewn together. This is called the neck because the bladder tapers or narrows down compared to where it is wider up top.
urethra
bladder
This new connection usually works well. But about 5% of the time, a scar tissue (shown in green) can develop at the connection. This risk of developing a scar tissue can go up to 15% if a man received radiation therapy in addition to prostate removal. This scar tissue can block the flow of urine.
urethra
bladder
When a scar tissue develops at the bladder-urethra connection (shown in green), the first treatment we try is often a balloon dilation. A thin deflated balloon is threaded up to the scar tissue area and then inflated.
urethra
bladder
The inflated balloon cracks the scar tissue. Scar tissue is not stretchable; so, the dilation causes several fissures (or splits) in the scar.
Hopefully, at the base of these cracks is some healthy tissue. When that tissue heals in the cracks, it should re-line with urethra tissue rather than scar tissue. That is what turns a temporary success into a long-term success.
Urethral stricture (green)
Dilation creates cracks in the stricture, exposing underlying healthy tissue (pink)
If healthy urethra grows in the exposed areas then we have a long-term success
But, if scar tissue grows in these cracks then the success will only last a few weeks
The success rate of balloon dilation for scar tissue at the bladder-urethra connection (or bladder neck) depends on many factors, like how long or dense the scar is, how many times the scar has already been dilated, and whether the man has also received radiation or not. But, in the best case scenario (short, thin scar, with no prior treatment and no radiation) the success is 50-70%).
Optilume is a new treatment available worldwide. Dr. Elliott was the principal investigator of the Phase I, II and III trials of Optilume. This means he was one of the first people in the world to use Optilume and was the head physician in charge of running the trials that demonstrated the success of Optilume.
urethra
bladder
Optilume is a balloon that is coated with a drug (paclitaxel) that blocks scar tissue growth. In this figure, the drug is shown as small, grey snowflakes.
Just like a regular balloon, the Optilume created cracks in the scar tissue; the difference is that it deposits the paclitaxel into the base of these cracks. Paclitaxel helps block the scar formation during the first few critical weeks of healing and then is washed out of your tissues.
The main clinical trial randomized 126 men with urethral stricture NOT due to prostate surgery or radiation to either receiving a plain balloon or an Optilume. Success rates at 1 year were 3-times better with Optilume (about 75% compared to 25%). We do not know if these results will translate to better success in strictures after prostate surgery or radiation; but we are working on studying that.