Urologic complications of radiation therapy for gynecologic malignancies

Urinary symptoms are not well correlated with histologic bladder alterations from irradiation. The most common sequelae of bladder irradiation are acute, chronic and hemorrhagic cystitis and vesicovaginal fistula. Urodynamic evaluation of the bladder function postirradiation revealed a reduction in peak flow rate, volume at first desire to void, bladder capacity and bladder compliance. An increase in the volume of residual urine was noted. Most of these variables returned to normal values 6 months after the completion of irradiation. Most studies have found no significant correlation between measured irradiation doses to a specific point and bladder complications. When only external irradiation is given, bladder complications are not observed until a bladder dose of 60 Gy is delivered. Complications are noted with a dose of 55 Gy if such a dose is largely contributed by intracavitary therapy. The contribution of brachytherapy to bladder complications acquires significance with an external dose of 40 Gy or lower.