The scope, presentation, and management of genitourinary complications in patients presenting with high-grade urethral complications after radiotherapy for prostate cancer

Authors

  • R. Christopher Doiron
  • Jon Witten
  • Keith F. Rourke University of Alberta

DOI:

https://doi.org/10.5489/cuaj.6599

Keywords:

radiotherapy, GU complications, urethral stricture, urethroplasty

Abstract

Introduction: The scope of complications arising after radiotherapy (RT) treatment for prostate cancer is under-recognized and not well-described. The objective of this study is to describe the presentation, scope, and management of genitourinary (GU) complications 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 5.1±2.2. 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%), GU pain (n=28, 23.3%), and prostate necrosis/abscess (n=17, 14.2%). Patients required a mean of 7.4±4.4 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.

Downloads

Download data is not yet available.

Author Biography

Keith F. Rourke, University of Alberta

Associate Professor,

Division of Urology,

Department of Surgery,

University of Alberta

Published

2020-07-17

How to Cite

Doiron, R. C. ., Witten, J. ., & Rourke, K. F. (2020). The scope, presentation, and management of genitourinary complications in patients presenting with high-grade urethral complications after radiotherapy for prostate cancer. Canadian Urological Association Journal, 15(1), E6–10. https://doi.org/10.5489/cuaj.6599

Issue

Section

Original Research

Similar Articles

1 2 > >> 

You may also start an advanced similarity search for this article.