Evaluation and treatment of female stress urinary incontinence after pelvic radiotherapy

Abstract

Introduction Pelvic radiotherapy is associated with both acute and chronic voiding dysfunction. A review of the success and complications of surgical treatments for female stress urinary incontinence after pelvic radiotherapy has not been summarized in the published literature. Methods A systematic review of female stress urinary incontinence after pelvic radiotherapy was conducted using MeSH terminology (1988‐2018). Results There is limited published literature on the treatment of stress urinary incontinence in women following pelvic radiotherapy. Long term indwelling urethral catheter should be avoided in all women given the risk of iatrogenic hypospadias. Surgical treatments can be classified into those for the intact versus failed outlet. Urethral bulking injections have been studied in a prospective fashion specifically in women with stress urinary incontinence after radiotherapy and although not randomized, have the highest level of evidence. Patients should be screened for a history of prior radiotherapy before considering sling placement. Artificial urinary sphincter is associated with a high rate of erosion after prior radiotherapy. The role of Burch colposuspension in patients with prior radiotherapy is poorly defined. Urinary diversion should be considered for patients with a devastated outlet. Conclusions Since the long‐term effects of radiotherapy on lower urinary tract voiding function are typically irreversible and progressive, further research is needed to mitigate the adverse effects of irradiation and identify more durable treatment options for women with radiation induced bladder dysfunction and stress urinary incontinence.

Radiation induced bladder dysfunction in women during the acute and chronic phases following pelvic radiotherapy in a prospective observational cohort

“…Following enrollment, history was recorded and participants answered self-administered questionnaires which included the American Urological Association Symptom Score (AUASS) [14], the ICIQ-FLUTS [13], and the 12 item short form health survey (SF12) [15]. Radiation Therapy Oncology Group (RTOG) scores [5,6] were extrapolated from patient notes and symptom questionnaires. To allow comparison of symptoms after radiotherapy with baseline LUTS, in the before radiotherapy phase, an RTOG grade of 0 was assigned for "no/mild LUTS" rather than "no change".…”

“…Oncology Group (RTOG) has clearly de ned genitourinary radiotoxicity using a grading system for acute effects on the lower urinary tract occurring < 90 days after completion of radiotherapy, and late/chronic adverse effects occurring thereafter [5,6]. Long term urinary adverse events following radiotherapy represent a signi cant disease burden.…”

“…Given the close proximity of the cervix and vaginal cuff to the bladder, RTOG grade 1 and 2 urinary adverse events are present in up to 45% of patients at 5-years and major complications related to grade 3 adverse events noted in 14% of patients at 20-years [7][8][9]. Since the RTOG is the most commonly used radiation toxicity grading system for LUTS in the gynecologic oncology literature [5,6], it may pose a problem that this score doesn't account for pre-radiation LUTS, which are quite prevalent in the general population, and affect about two-thirds of adult females [10,11].…”

Reliability of ultrasound imaging of pelvic floor morphology and function among females who have undergone pelvic radiotherapy

“…[2][3][4][5][6][7] Morphological and functional alterations such as shortening of the urethra or decreased squeeze pressure of the anal sphincter have been described after RT in the pelvic area, and are thought to be related to the high prevalence of pelvic floor dysfunctions reported after pelvic cancer treatments. [8][9][10][11][12][13][14] The study of radiation-induced changes in the lower urinary tract and the associated pelvic floor muscles (PFMs) may increase our understanding of the factors upon which therapies may be based to reduce or prevent iatrogenic conditions such as incontinence and pelvic pain. Yet, evidence on the measurement properties of urogenital morphology and parameters related to PFM function in this population remains scarce.…”

“…RT alters tumor morphology and physiology, but also that of surrounding organs and tissues 2–7 . Morphological and functional alterations such as shortening of the urethra or decreased squeeze pressure of the anal sphincter have been described after RT in the pelvic area, and are thought to be related to the high prevalence of pelvic floor dysfunctions reported after pelvic cancer treatments 8–14 . The study of radiation‐induced changes in the lower urinary tract and the associated pelvic floor muscles (PFMs) may increase our understanding of the factors upon which therapies may be based to reduce or prevent iatrogenic conditions such as incontinence and pelvic pain.…”