Introduction <p>Radiation induced urethral stenosis disease represents a complex subset of patients with higher rates of recurrence after treatment. Optilume^®, a Paclitaxel drug-coated balloon, has been utilized in anterior urethral strictures with promising results. Although urethroplasty is traditionally regarded as the gold standard for treating radiation-induced posterior urethral stenosis, it can be an invasive and challenging procedure with potential side effects. We aim to evaluate the efficacy of the Optilume^® drug-coated balloon as a minimally invasive treatment option for radiation-induced posterior urethral stenosis.</p> Methods <p>A retrospective, multi-institutional review was conducted on male patients who underwent Optilume^® drug-coated balloon dilation from January 1, 2022, to November 1, 2023. The study involved five surgeons across four institutions. Patients were investigated based on their history of radiation-induced posterior urethral stenosis, and comparisons were made regarding demographics, characteristics of urethral stenosis, and outcomes, including surgical success and complications.</p> Results <p>Among the 56 patients with radiation-induced posterior urethral stenosis evaluated across all four institutions, 37 men had at least 90-day follow-up data. Of these 37 patients, 30 (81.1%) were deemed successful, defined as being free from repeat intervention. Although 6 patients (10.7%) experienced complications, none were greater than Clavien IIIb, with the most common complication being acute urinary retention.</p> Conclusion <p>Although radiation-induced urethral stenosis is typically associated with high rates of recurrence following conservative treatment, Optilume^® drug-coated balloon represents an alternative endoscopic treatment option with encouraging short-term results.</p>