Urodynamic assessment of short-term effects of pelvic radiotherapy on bladder function in patients with gynecologic cancers

Abstract

Objectives: To determine the short-term effects of adjuvant or primary curative radiotherapy (RT) on the urinary system in women with gynecologic cancer. Material and methods:This is a prospective, concurrent cohort study including 55 patients with gynecologic cancer who were divided into three groups. Group 1 included 10 patients who were administered adjuvant RT following a radical hysterectomy (RH); Group 2 included 36 patients who were administered adjuvant RT following a type 1 hysterectomy and Group 3 included 9 patients who were administered primary curative RT. Urogynecologic assessments were carried out on patients before and six months after the treatment.Results: Compared to pretreatment, no significant differences were observed in any of the three groups after treatment in terms of incontinence, first urge to urinate, normal urge to urinate, severe urge to urinate and changes in residual urine volumes. There was a significant decrease in maximal vesical pressure after treatment in Group 1 and Group 3. The maximum detrusor pressure decreased significantly in Group 1. The post-treatment decline in bladder capacity in Group 1 and Group 2 was also significant. Conclusions:RH and pelvic RT cause lower urinary system dysfunction. Especially patients who receive primary curative RT and patients who are administered RT after RH, where more pelvic denervation occurs, are at higher risk due to high doses of RT.

Management of voiding dysfunction associated with pelvic malignancies

“…As many women being treated with pelvic RT also undergo radical pelvic surgery for their malignancy, understanding the isolated effect of RT in voiding dysfunction development is challenging. As described previously, RT causes a decrease in bladder compliance, most likely secondary to abnormal epithelial proliferation and fibrin deposition within detrusor fibers, cell apoptosis, and chronic endarteritis 31 …”

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

“…Emirdar et al [21] have performed urodynamic studies and physical examination for incontinence and compared patient status both before, and 6 months after radiotherapy. Bladder capacity was decreased signi cantly in all subjects, and mostly in those undergoing radical pelvic surgery in combination with the lowest dose of radiation (mean decrease in capacity from 600 to 490 mL).…”

Radiotherapy is associated with reduced continence outcomes following implantation of the artificial urinary sphincter in men with post-radical prostatectomy incontinence

“…[ 25 ] This is confirmed in the reports of higher rates of persistent urinary incontinence post-AUS implantation in those men treated with adjuvant and neoadjuvant radiotherapy, with rates ranging from 5% to 48%. [ 19 23 24 25 26 27 28 29 30 31 32 33 34 ]…”

“…Persistent urinary incontinence following AUS implantation may not be consequent to persistent intrinsic sphincter deficiency secondary but due to bladder factors such as de novo detrusor overactivity, loss of compliance, or loss of capacity. [ 26 27 28 ] All which are known to occur following radiotherapy to the bladder. The variation in continence outcomes described in the literature is consequent to variation in radiotherapy dose and techniques, patient selection bias, and variation in the definition of continence, outcomes measures and follow-up.…”

“…Reports vary widely, ranging from 5% to 40%. [ 2 23 28 29 30 31 32 33 34 ] The varying rates may well be due to small cohort numbers, incomplete data, and/or inconsistent follow-up particularly with patient satisfaction and QOL questionnaires. Certainly, the surgical revision rates reported for irradiated patients are consistently higher than those in nonirradiated patients.…”