Treatment of voiding dysfunction following radiation therapy for carcinoma of the prostate

Radiation therapy for the treatment of prostate cancer has made tremendous advances in the past century but is still associated with significant urinary morbidities. These complications are divided into acute and late toxicities. Among the recognized acute toxicities are dysuria and urinary retention. Management differs from late toxicities, which may include urethral strictures, fistulas, and radiation-induced hemorrhagic cystitis. Although identical problems are seen in the absence of radiation, the management of these complications is altered by the additive effect of radiotherapy. This is likely due to progressive obliterative endarteritis triggered by radiation therapy. On the basis of the evolving tissue effects of radiotherapy, each treatment should be individualized and tailored to the patient, form and dosage of radiation, and the tissue quality.