Open AccessThe scope, presentation, and management of genitourinary complications in patients presenting with high-grade urethral complications after radiotherapy for prostate cancer
Author(s) -
Roseline d’Oiron,
Jon Witten,
Keith Rourke
Publication year - 2020
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.6599
Subject(s) - medicine , prostate cancer , artificial urinary sphincter , surgery , lower urinary tract symptoms , urinary incontinence , transurethral resection of the prostate , urinary retention , prostatitis , urology , radiation therapy , genitourinary system , urethral stricture , prostate , sphincter , urethra , cancer
The scope of complications arising after radiotherapy (RT) treatment for prostate cancer is underrecognized and not well-described. The objective of this study is to describe the presentation, scope, and management of genitourinary complications (GU) in patients referred for high-grade urethral complications or sphincter weakness incontinence after prostate RT.
Methods: A retrospective review was performed of patients referred to a reconstructive urologist for management of grade 4 urethral complications and sphincter weakness incontinence after prostate RT from December 2004 to December 2015. Patients’ signs, symptoms, complications, and treatments are described.
Results: A total of 120 patients were identified with a mean age of 67.8 years; 55.8% (n=67) received external beam radiotherapy (EBRT), 38.3% (n=46) brachytherapy (BT), and 5.8% (n=7) combination RT. The mean time to first complication after RT was 57.7 months (1–219) and number of complications per patient was 5.12.2. The most common associated complications were urethral stenosis (n=106, 88.3%), sphincter weakness urinary incontinence (n=55, 45.8%), radiation cystitis (n=61, 50.8%), refractory storage lower urinary tract symptoms (n=106, 88.3%), genitourinary pain (n=28, 23.3%), and prostate necrosis/abscess (n=17, 14.2%). Patients required a mean of 7.44.4 treatments over a 33-month period, including urethral dilation/urethrotomy (n= 93, 77.5%), urethroplasty (n=53, 44.2%), transurethral resection (n=52, 43.3%), cystolithopaxy (n=14, 11.7%), artificial urinary sphincter (n=8, 6.7%), and urinary diversion (n=8, 6.7%). Patients with RT combined with other modalities had more complications (6.2 vs. 4.2, p=0.001), higher rates of incontinence (93.8% vs. 29.5%, p=0.001), necrosis (31.3% vs. 8.0%, p=0.003), erectile dysfunction (84.4% vs. 51.1%, p=0.001), and hematuria (59.4% vs. 36.4%, p=0.04).
Conclusions: Urethral complications related to prostate RT are seldom an isolated problem and require a substantial amount of urological resources and interventions.