Lower Urinary Tract Complications After Radiotherapy for Prostate Cancer: An Organ-Based Clinical Framework.

PURPOSE: This study presents a structured narrative review of lower urinary tract (LUT) complications following prostate cancer (PCa) radiotherapy and proposes an organ-based clinical framework for their evaluation and management. MATERIALS AND METHODS: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science, including studies published between January 2000 and December 2025 and supplemented by seminal studies in radiation biology and reconstructive urology. Search terms included prostate cancer, radiotherapy, radiation cystitis, bladder dysfunction, urethral stricture, bladder neck contracture, urinary incontinence, urinary fistulae, ureteral stricture, and post-radiotherapy outlet surgery. Evidence was synthesized qualitatively and organized into organ-specific domains. RESULTS: Radiation-induced LUT complications include radiation cystitis, detrusor overactivity and impaired compliance associated with bladder fibrosis, urethral and bladder neck strictures, sphincteric insufficiency with urinary incontinence, urinary fistulae, and ureteral strictures. These conditions frequently coexist because of the multifocal and progressive nature of radiation injury. Management is challenging because tissue hypovascularity, fibrosis, and impaired healing increase the risks of recurrence, infection, erosion, and fistula formation. Evaluation requires integrated anatomical and functional assessment, including cystoscopy, urodynamics, and imaging when indicated. Conservative, endoscopic, and reconstructive treatments should be individualized according to bladder function, outlet status, tissue quality, and patient characteristics. CONCLUSIONS: LUT complications after prostate radiotherapy represent a complex and evolving spectrum of injury. An organ-based framework facilitates identification of the primary site of dysfunction, recognition of associated abnormalities, and appropriate staged management. As PCa survivorship increases, multidisciplinary care will be essential to optimize outcomes and reduce long-term morbidity.