Voiding dysfunction after radiation therapy for carcinoma of the prostate

Prostate cancer is the second leading cause of cancer deaths in the United States, and its treatment can be in the form of radiotherapy. Radiation therapy can be delivered in several different modalities, each offering its own unique morbidity profile. Radiation targeting the lower urinary tract tissue has both acute and long-term consequences. Depending on the modality of radiation and patient characteristics, the resultant voiding dysfunctions may include urinary obstruction, incontinence, strictures, and urodynamic changes. Voiding dysfunction after radiation therapy for prostate cancer is progressive by virtue of the insidious nature of obliterative endarteritis. Refinements in technique, such as intensity modulated radiation therapy and imaging guided brachytherapy, are geared toward improving cancer control while reducing complications. Treatment of the most severe complications are challenging due to poor tissue quality and limited blood supply. In the most extreme situations, urinary tract diversion may be necessary.