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Other Radiological Lesions Of The Lower Urinary Tract In Patients After Isolated Pelvic Radiotherapy And Combined With Surgery.
Autor: S. Méndez Rubio, J. Salinas Casado, M. Vírseda Chamorro, P. Gutiérrez Martín, M. Esteban Fuertes Y J. Moreno Sierra.
Editorial: Archivos Españoles de Urología
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who have undergone radiotherapy (RT)

and pelvic surgeries is uncommon in the literature, not

described in patients without complications, and mostly

related to urinary fistulae.

OBJECTIVE: The study of the lower urinary tract (LUT) by

cystography in these patients, with a description of some

other types of radiation lesions.

METHODS: 127 cystographies have been performed

(88 and 39 ) in consecutive patients undergoing

radiotherapy (RT) (48 monotherapy and 79 cases

combined with surgery), with a mean age of 69.6

years, and a mean time from radiation of 215 months

(17 years). A General Electric X ray equipment has been

used. We studied: behavior of the bladder neck at rest

and during micturition, assessment of vesicoureteral

reflux (VUR), bladder morphology (BM), urethral strictures

(UE) and fistulas (F).

RESULTS: We observed: Filling phase bladder

neck incompetence (BNI) (37.8%), bladder smooth

morphology (60.6%), coughing urinary incontinence

(UI) (26.4%), basal cystocele (64.7%) and Valsalva

cystocele (96.6%), a normal opening bladder neck

(96,1%), reduction of the urethral diameter during

voiding (41.3%), and vesicoureteral reflux (VUR)

(13.2%). Five cases of filling BNI, were all related to

prostate cancer (PC) (one of them with colon cancer as

well). There were six cases of fistulae (4.14%), five of

them women. Forty two patients (28.96%) had reduced

urethral lumen, thirty five of them affecting the posterior

urethra (83%), five (11.9%) the anterior and, finally, two

cases of mixed lesion (5%). 95% were patients with

PC without concurrent interventions (67%). Significant

differences were found regarding the gender and the

background of pelvic surgery. The filling BNI (p=0.007),

the irregular bladder morphology (p=0.004) and the

reduction of the urethral lumen (p<0.001) have been

found to be more common in male patients, while the

coughing UI was more common in women (p=0.007).

The study shows that BNI (p=0.046), VUR (p=0.02)

and the IU due to cough (p=0.03) were more frequent

in operated patients, while reduced urethral lumen was

less common (p<0.01). Patients with VUR present more

time from radiotherapy, but not in other cystography

variables. There was a relationship between RT and the

BNI, stress urinary incontinence, anterior urethral stricture

and VUR. The risk factor was increased by surgery.

CONCLUSIONS: Bladder neck incompetence, stress

UI, anterior urethral stricture and VUR have been related

to radiotherapy. Surgery increased the risk factor in

operated patients.

Sobre el editor:

Revista Internacional de Urología indexada y peer-reviewed, fundada en 1944, dirigida a toda la comunidad científica. Aquí encontrarás las últimas novedades y hallazgos urológicos. Publicamos 10 números anuales.