Doiron R Christopher, Witten Jon, Rourke Keith F
Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Can Urol Assoc J. 2021 Jan;15(1):E6-E10. doi: 10.5489/cuaj.6599.
The scope of complications arising after radiotherapy (RT) treatment for prostate cancer is under-recognized and not well-described. The objective of this study is to describe the presentation, scope, and management of genitourinary (GU) complications in patients referred for high-grade urethral complications or sphincter weakness incontinence after prostate RT.
A retrospective review was performed of patients referred to a reconstructive urologist for management of grade 4 urethral complications and sphincter weakness incontinence after prostate RT from December 2004 to December 2015. Patients' signs, symptoms, complications, and treatments are described.
A total of 120 patients were identified, with a mean age of 67.8 years; 55.8% (n=67) received external beam radiotherapy (EBRT), 38.3% (n=46) brachytherapy (BT), and 5.8% (n=7) combination RT. The mean time to first complication after RT was 57.7 months (1-219) and number of complications per patient was 5.1±2.2. The most common associated complications were urethral stenosis (n=106, 88.3%), sphincter weakness urinary incontinence (n=55, 45.8%), radiation cystitis (n=61, 50.8%), refractory storage lower urinary tract symptoms (n=106, 88.3%), GU pain (n=28, 23.3%), and prostate necrosis/abscess (n=17, 14.2%). Patients required a mean of 7.4±4.4 treatments over a 33-month period, including urethral dilation/urethrotomy (n= 93, 77.5%), urethroplasty (n=53, 44.2%), transurethral resection (n=52, 43.3%), cystolithopaxy (n=14, 11.7%), artificial urinary sphincter (n=8, 6.7%), and urinary diversion (n=8, 6.7%). Patients with RT combined with other modalities had more complications (6.2 vs. 4.2, p=0.001), higher rates of incontinence (93.8% vs. 29.5%, p=0.001), necrosis (31.3% vs. 8.0%, p=0.003), erectile dysfunction (84.4% vs. 51.1%, p=0.001), and hematuria (59.4% vs. 36.4%, p=0.04).
Urethral complications related to prostate RT are seldom an isolated problem and require a substantial amount of urological resources and interventions.
前列腺癌放射治疗（RT）后出现的并发症范围尚未得到充分认识，描述也不详尽。本研究的目的是描述因前列腺RT后出现高级别尿道并发症或括约肌无力性尿失禁而转诊的患者泌尿生殖系统（GU）并发症的表现、范围及管理。
对2004年12月至2015年12月因前列腺RT后4级尿道并发症和括约肌无力性尿失禁而转诊至重建泌尿外科医生处的患者进行回顾性研究。描述了患者的体征、症状、并发症及治疗情况。
共确定120例患者，平均年龄67.8岁；55.8%（n = 67）接受了外照射放疗（EBRT），38.3%（n = 46）接受了近距离放疗（BT），5.8%（n = 7）接受了联合放疗。RT后首次出现并发症的平均时间为57.7个月（1 - 219个月），每位患者的并发症数量为5.1±2.2。最常见的相关并发症为尿道狭窄（n = 106，88.3%）、括约肌无力性尿失禁（n = 55，45.8%）、放射性膀胱炎（n = 61，50.8%）、难治性储尿期下尿路症状（n = 106，88.3%）、GU疼痛（n = 28，23.3%）以及前列腺坏死/脓肿（n = 17，14.2%）。患者在33个月期间平均需要7.4±4.4次治疗，包括尿道扩张/尿道切开术（n = 93，77.5%）、尿道成形术（n = 53，44.2%）、经尿道切除术（n = 52，43.3%）、膀胱碎石术（n = 14，11.7%）、人工尿道括约肌植入术（n = 8，6.7%）以及尿流改道术（n = 8，6.7%）。接受RT联合其他治疗方式的患者并发症更多（6.2比4.2，p = 0.001），尿失禁发生率更高（93.8%比29.5%，p = 0.001），坏死发生率更高（31.3%比8.0%，p = 0.003），勃起功能障碍发生率更高（84.4%比51.1%，p = 0.001），血尿发生率更高（59.4%比36.4%，p = 0.04）。
与前列腺RT相关的尿道并发症很少是孤立问题，需要大量的泌尿外科资源和干预措施。
