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Genitourinary toxicity following radiation therapy is not just about haematuria- lessons from 7 years of a specialist radiation cystitis clinic.

J. Kam^1,2,3, G. Heaver-Wren¹, F. Del Guidice¹, Y. ABU-GHANEM¹, E. Mensah¹, R. Nair¹, M. Khan¹, R. THURAIRAJA¹

¹Guy's Hospital, London, United Kingdom
²Nepean Urology Research Group, Sydney, Australia
³University of Sydney, Sydney, Australia

Introduction:

Radiation therapy for treatment of various pelvic cancers in both genders is being widely utilized. With improved survivorship, a significant number of these patients experience genitourinary toxicity which more commonly manifests as radiation cystitis/visible haematuria. However, non-haematuria symptoms of toxicity are often overlooked and are difficult to manage. We aimed to investigate the incidence of non-haematuria genito-urinary toxicity symptoms in patients presenting to our specialist radiation cystitis service and analyse if these were more prevalent in specific treatment groups.

Material and methods:

We analysed our prospectively maintained specialist radiation cystitis clinic database for patients treated at our centre between January 2016-Sept 2024. Demographic data was collated and additional information on non-haematuria related symptoms were collected from patient charts. Data was analysed using SPSS 29.

Results:

219 patients were identified for analysis. 169 (77%) were male with a median age of 72 (Range 26-96). The mean time from radiation treatment to symptoms of genitourinary toxicity was 3 years (Range <1 year to 17 years). The primary diagnosis for radiation treatment were bladder cancer 13 (6%), prostate cancer 157 (72%), colorectal cancer 4 (2%), cervical cancer 36 (16%) and endometrial cancer 9 (4%). Non-haematuria symptoms were highly prevalent in this patient cohort. Symptoms included incontinence (54.3%), urinary tract infections (21.9%), chronic pelvic pain (32.4%), concurrent bowel symptoms (24.2%), hydronephrosis (14%), urethral strictures (9.1%) and fistulas (7.3%). Chronic pelvic pain was more prevalent in patients undergoing radiotherapy for cervical cancer than all other cancers (58% vs. 27%, p<0.002). There were no other differences in the incidence of these symptoms between the different cancer groups. Sub-analysis of the patients with prostate cancer showed no difference in the incidence of non-haematuria genitourinary toxicity in between patients undergoing brachytherapy, primary external beam radiotherapy or adjuvant/salvage radiotherapy. 17 of these patients ultimately required salvage cystectomy for non-haematuria genitourinary toxicity indications.