Identifying Risk Factors for Post-Radiotherapy Urethral Strictures in Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Introduction: The primary aim of this systematic review and meta-analysis is to investigate and identify the risk factors for urethral strictures after radiotherapy in patients with prostate cancer (PC).Methods: MEDLINE, Embase, Web of Science (WOS) and Scopus were searched until December 1, 2024. Based on the eligibility criteria, two independent investigators selected the research for inclusion. We collected data on the patient characteristics, study design, and the number of patients with and without urethral strictures after radiotherapy in exposure positive and negative groups. To reach pooled measures of the risk ratio, STATA version 17.0 was used. In order to evaluate heterogeneity between articles, I2 were used.Results: We identified 1325 unique articles, 55 of which had potential relevance. 5 articles were considered for inclusion in the review as they met the inclusion criteria. Our study found that a history of transurethral resection of the prostate (TURP) was associated with an increased risk of post-radiotherapy urethral stricture (RR=1.56, 95% CI: 0.85 to 2.85; P-value=0.15). Diabetic patients had a significantly lower risk of developing strictures (RR=0.50, 95% CI: 0.26 to 0.95; P-value=0.03). Non-significant reductions in stricture risk were observed among patients older than 65 years (RR = 0.65, 95% CI: 0.37 to 1.14; P-value=0.13) and those with hypertension (RR=0.30, 95% CI: 0.06 to 1.45; P-value=0.13). No association was found between smoking and urethral stricture risk (RR=1.02, 95% CI: 0.99 to 1.04; P-value=0.15). There was no considerable publication bias.Conclusion: Our findings highlight key risk factors for post-radiotherapy urethral stricture, emphasizing the need for clinicians to focus on high-risk patients, such as those with a history of TURP.