Radiotherapy effects on the lower urinary tract: A review of long-term complications and their management

Radiotherapy of the pelvis and abdomen can have significant negative long-term effects on the bladder and urethra. Applying the PICO criteria, we reviewed the MEDLINE/PUBMED databases over a 10-year period for literature on the incidence and prevalence of late adverse effects of radiotherapy on the lower urinary tract; the work-up and management of these adverse effects. Overactive bladder, hemorrhagic cystitis, fistula, stress urinary incontinence, bladder neck contracture, urethral stricture, and secondary malignancy were investigated as late complications of radiotherapy on the bladder and urethra. These sequalae may present in the decades following radiotherapy usually with greater symptom severity than those non-irradiated and will often have less favourable outcomes with traditional management strategies that are applied in the absence of radiation. Experimental therapies are being trialed. Our findings reinforce that patients with radiotherapy-related complications most often have poorer outcomes with traditional management strategies such as male urethral slings for stress incontinence and fistula repair, however this review identified successful outcomes for treatments such as the artificial urethral sphincter for incontinence, and hyperbaric oxygen therapy for hemorrhagic cystitis. Further research is required - particularly with a focus on the irradiated female population.