Abstract: PD29-05
Sources of Funding: None

Introduction

Radiotherapy is one of the most commonly employed treatments for localized prostate cancer. Complications arising from these treatments are not well defined. Our objective is to better define the scope and management of lower urinary tract complications after prostate radiotherapy.

Methods

A retrospective review was performed of patients with severe urethral complications related to prostate radiotherapy referred to a single urologist over a 11-year period (Dec 2004 to Dec 2015). Records were reviewed to describe patient signs, symptoms, complications and treatments. Complications included urethral stricture/stenosis/contracture, incontinence, erectile dysfunction, prostate necrosis/abscess, pubic osteomyelitis/fistula, UTI, hematuria, acute urinary retention, genitourinary pain, radiation proctitis, radiation cystitis, rectourethral fistula and de novo (secondary) malignancy. Descriptive statistics, Fishers exact test and unpaired t-test were employed where appropriate to summarize clinical findings.

Results

120 patients were identified at a mean age of 67.8 years and a mean RTOG morbidity score of 3.9. The mean time to first complication after radiotherapy was 57.7 months (1-219) and number of complications per patient was 5.1(±2.2). 55.8% of patients had external beam radiotherapy, 38.3% had brachytherapy and 5.8% had combined radiation modalities. The most common complications were urethral stricture/stenosis (88.3%), refractory storage LUTS (88.3%), incontinence (45.8%), erectile dysfunction (60.0%), radiation cystitis (50.8%), acute urinary retention (50.0%) and hematuria (42.5%). Other notable complications included prostate necrosis/abscess (14.2%), pubic osteomyelitis/prostatosymphyseal fistula (3.3%), de novo cancer (5.8%), and rectourethral fistula (0.8%). Patients required a mean of 7.4±4.4 (1-30) treatments for radiation related complications over the study period and 49.2% of patients required major urologic surgery. Required procedures included urethral dilation/urethrotomy (77.5%), urethral reconstruction (44.2%), incontinence surgery (6.7%), transurethral resection (prostate, bladder, contracture)(43.3%), cystolithopaxy (11.7%) and urinary diversion (6.7%). 13.3% of patients were treated with an indwelling suprapubic catheter. Patients with complications related to combined radiotherapy had more complications (7.0 vs. 5.0; p=0.016) including incontinence (85.7% vs. 44.2%; p=0.04), de novo malignancy (28.6% vs. 4.4%; p=0.05), pubic osteomyelitis (28.6% vs. 1.8%; p=0.02), and tended to require a higher number of procedures (10.1 vs. 7.2; p=0.08)._x000D_

Conclusions

Lower urinary tract complications related to radiotherapy are very seldom an isolated problem and require a tremendous amount of resources and urologic intervention. Patients with combined radiotherapy complications have a higher number of complications and typically require more interventions.

Funding

None