LATE UROLOGICAL COMPLICATIONS OF PELVIC RADIOTHERAPY PRESENTING TO A TERTIARY CARE INSTITUTE

Background: The present study aims to assess various presentations of radiotherapy-induced late urological complications and management done in a tertiary care institute. Methods: A prospective study was carried outin two-year which included 30 patients.Patients who received pelvic radiotherapy anytime in the past and presented with complications related to it were included. Their demographic data, primary malignancy, radiotherapy details, presentations, complications and management done were studied. Results: The mean age and interquartile range of patients was 59.76 yr. (57 – 65 yr.). 23 patients (76.66%) were females. Ca cervix was the most common indication for primary radiotherapy (20 patients) followed by ca prostate (six patients). The mean duration of presentation after radiotherapy was 11.96 year with EBRT being the most common modality.The median dose per fraction (IQR) was 2 (2) Gy per fraction. The median number of fractions (IQR) of radiation therapy was 25 (20 – 31.25) and the median total dose (IQR) was 50 Gy (40 – 70.50 Gy). Radiation-induced hemorrhagic cystitis was the most common complication in 15 patients (50%). Other complications include urethral stricture, ureteral stricture and vesicovaginal fistula. The surgical intervention rate was 63.33%. Cystourethroscopy, clot evacuation and electrocoagulation was the most common procedure done in 23.33%. Other operative intervention includes ileal conduit with or without cystectomy, vesicovaginal fistula repair and transureteroureterostomy. Conclusion: Complications of pelvic radiotherapy can manifest very late, are usually irreversible in nature and frequently needs surgical management. Surgery remains the mainstay of treatment modality for many of the complications.