Radiotherapy‐related complications presenting to a urology department: a more common problem than previously thought?

• Published in: BJU international 2018-05, Vol.121 (S3), p.28-32
• Main Authors: Ma, Joyce L., Hennessey, Derek B., Newell, Bradley P., Bolton, Damien M., Lawrentschuk, Nathan
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Bladder cancer; Brachytherapy - adverse effects; Cohort Studies; complications; Demography; Dose-Response Relationship, Radiation; emergency admission; Emergency Service, Hospital - statistics & numerical data; Emergency Treatment - statistics & numerical data; Female; Humans; Incidence; Male; Patient Admission - statistics & numerical data; Patient admissions; Prognosis; Prostate cancer; radiation cystitis; Radiation Injuries - diagnosis; Radiation Injuries - epidemiology; Radiation Injuries - surgery; Radiation therapy; radiotherapy; Radiotherapy - adverse effects; Retrospective Studies; Risk Assessment; Survival Rate; Tertiary Care Centers; United States; Urologic Neoplasms - pathology; Urologic Neoplasms - radiotherapy; Urology
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.14145

Objective To quantify the burden of the side effects of radiotherapy on a tertiary referral urology department. Patients and Methods A prospective study of all urology admissions to a public urology department at a tertiary hospital in a 6‐month period was performed. Patients admitted with complications attributable to radiotherapy were included in the study. Data obtained included patient demographics, radiotherapy details, complication type and management required. Results A total of 1198 patients were admitted; 921 (77%) were elective and 277 (23%) were emergency admissions. Thirteen out of the 921 (1.4%) elective admissions and 20 out of the 277 (7.2%) emergency admissions were attributable to radiotherapy complications. Radiotherapy complications was the fourth most common reason for emergency admission, ahead of acute urinary retention. These 33 admissions were accounted for by 21 patients. A total of 39 separate complications attributable to radiotherapy were diagnosed, with some patients having multiple complications. The median (interquartile range) time to onset of complications was 4 (1–9) years. The surgical intervention rate was 67%. The commonest procedures were washout with/without clot evacuation or diathermy in theatre (15.8%) and urethral dilatation/bladder neck incision (15.8%). Two urinary diversions and two cystoprostatectomies plus urinary diversion were performed. Conclusion Radiotherapy complications are consequential and account for a substantial proportion of a tertiary urology department's emergency workload. These complications generally occur years after radiotherapy and frequently require surgical intervention.