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

Abstract

Background Lower urinary tract symptoms (LUTS) are common after pelvic radiotherapy (XRT), but most existing literature does not account for pre-XRT symptoms. Our aim was to characterize changes in LUTS before, during, and after (acute, chronic) XRT. Methods Adult women were prospectively enrolled into an observational cohort over a 10 month period from radiation oncology (Short Term group, ST) and urology (Long Term group, LT) clinic. Instruments included the American Urological Association Symptom Score (AUASS), Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), Short form 12 item health survey, and Radiation Therapy Oncology Group (RTOG) genitourinary toxicity grading system. Data were analyzed in SAS. Results Twenty women were recruited (mean age 59.1 ± SD14.8 years, n = 12 ST, n = 8 LT) with a median follow-up of 9 (ST,IQR 7–50) and 6,170 (LT,IQR: 2,194-8,755) days since XRT [brachytherapy (55%,11/20), external beam (15%,3/20), combination (30%,6/20)]. Storage, voiding and incontinence were mildly worse during XRT (not significant). Storage and incontinence LUTS were prevalent before and after XRT. Worse LT scores (vs. ST) were captured by both AUASS and FLUTS for urgency (p < 0.005) and frequency (p < 0.05). Incontinence was worse in LT and only ascertained by the FLUTS (p < 0.05). AUASS quality of life was worse in ST during XRT (p < 0.05), and in LT after XRT (p < 0.05) when compared to ST. RTOG grade 3–4 toxicity was common (63%,5/8) in the LT group, and not identified at any point during XRT in ST. Conclusions XRT is associated with worse LT storage and incontinence, while differences in voiding symptoms did not reach statistical significance.