Research Article
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The impact of radiotherapy on lower urinary tract symptoms in patients with gynecologic malignancies: a cross-sectional study

Year 2024, Volume: 41 Issue: 3, 510 - 514, 30.09.2024

Abstract

This study investigates the impact of radiotherapy (RT) on lower urinary tract symptoms (LUTS) in patients with gynecologic malignancies, focusing on those who have undergone surgical treatment. We conducted a cross-sectional study from January to June 2023 at a tertiary hospital’s outpatient polyclinic. Participants included patients with early-stage cervical cancer and endometrial cancer who received adjuvant RT post-surgery, and advanced cervical cancer patients who received primary RT. Patients were divided into two groups: those who received RT (RT (+)) and those who did not receive (RT (-)). Sociodemographic data were collected and LUTS were assessed using the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Out of 64 patients, 38 (59%) did not receive RT and 26 (41%) received RT. The RT (+) group had significantly higher scores in filling (p=0.038), voiding (p=0.046), and incontinence (p=0.012) compared to the RT (-) group. Additionally, the RT (+) group reported a significantly lower quality of life (p=0.009). Our study found that radiotherapy is associated with increased lower urinary tract dysfunction, including symptoms in the filling, voiding, and incontinence phases. Patients who received RT also experienced a decreased quality of life compared to the RT (-) group. These findings highlight the need for comprehensive management of LUTS in patients undergoing radiotherapy for gynecologic cancers.

Ethical Statement

The database management in accordance with privacy legislation and the presented study in accordance with the ethical principle of the Declaration of Helsinki. Ethical approval for this study was obtained by the Research Ethics Committee (Approval number:2023/514/259/2). The work has not been published previously and it is not under consideration for publication elsewhere.

Supporting Institution

None.

Thanks

The authors would like to thank the study participants for their contribution.

References

  • Fabian A, Krug D, Alkatout I. Radiotherapy and Its Intersections with Surgery in the Management of Localized Gynecological Malignancies: A Comprehensive Overview for Clinicians. J Clin Med. 2020;10(1):93.
  • Aue-Aungkul A, Kietpeerakool C, Rattanakanokchai S, Galaal K, Temtanakitpaisan T, Ngamjarus C, et al. Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer. Cochrane Database Syst Rev. 2021;1(1):CD012863.
  • Ziętek-Strobl A, Futyma K, Kuna-Broniowska I, Wojtaś M, Rechberger T. Urogynaecological Symptoms among Oncological Survivors and Impact of Oncological Treatment on Pelvic Floor Disorders and Lower Urinary Tract Symptoms. A Six-Month Follow-Up Study. J Clin Med. 2020; 30;9(9):2804.
  • Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS, et al. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 2009;103 Suppl 3:4-11.
  • Bruno V, Chiofalo B, Logoteta A, Brandolino G, Savone D, Russo M, et al. Urological Complications in Radical Surgery for Cervical Cancer: A Comparative Meta-Analysis before and after LACC Trial. Journal of Clinical Medicine. 2023; 12(17):5677.
  • Ramaseshan AS, Felton J, Roque D, Rao G, Shipper AG, Sanses TVD. Pelvic floor disorders in women with gynecologic malignancies: a systematic review. Int Urogynecol J. 2018;29(4):459-76.
  • Zwaans BMM, Lamb LE, Bartolone S, Nicolai HE, Chancellor MB, Klaudia SW. Cancer survivorship issues with radiation and hemorrhagic cystitis in gynecological malignancies. Int Urol Nephrol. 2018;50(10):1745-51.
  • Cho OH, Yoo YS, Kim JC, Park RH, Hwang KH. Factors Influencing Lower Urinary Tract Symptoms in Advanced Cancer Patients With Chemotherapy-Induced Peripheral Neuropathy. Int Neurourol J. 2018;22(3):192-9.
  • Chess-Williams R, McDermott C, Sellers DJ, West EG, Mills KA. Chronic psychological stress and lower urinary tract symptoms. Low Urin Tract Symptoms. 2021;13(4):414-24.
  • Helfand BT, Lee JY, Sharp V, Foster H, Naslund M, Williams OD, et al. Associations between improvements in lower urinary tract symptoms and sleep disturbance over time in the CAMUS trial. J Urol. 2012;188(6):2288-93.
  • Bristol Urological Institute, Internacional Consultation on Incontinence Modular Questionnaire (ICIQ). Available at. http://iciq.net. Accessed 28 Oct 2023.)
  • Gungor Uğurlucan F, Yasa C, Yuksel Ozgor B, Ayvacikli G, Gunaydin C, Balci BK, et al. Validation of the Turkish version of the ICIQ-FLUTS, ICIQ-FLUTS long-form, ICIQ-LUTS quality-of-life, and ICIQ-FLUTS sexual functions. Neurourol Urodyn. 2020;39(3):962-8.
  • Brown JS, Sawaya G, Thom DH, Grady D. Hysterectomy and urinary incontinence: a systematic review. Lancet. 2000;356(9229):535-9.
  • Keles E, Alınca CM, Ozturk UK, Oktay Korucuoglu F, Api M, Baydili KN. Quality of life, psychosocial distress in Gynecologic Oncology Patients: A Tertiary Center Experience. Kocaeli Medical Journal. 2023;12(1):14–23.
  • Oh JK, Choo MS, Lee J, Park NH, Oh SJ. Short-term effect of radical hysterectomy with or without adjuvant radiation therapy on urodynamic parameters in patients with uterine cervical cancer. Int Neurourol J. 2012;16:91–5.
  • Hazewinkel MH, Sprangers MA, van der Velden J, van der Vaart CH, Stalpers LJ, Burger MP, et al. Long-term cervical cancer survivors suffer from pelvic floor symptoms: a cross-sectional matched cohort study. Gynecol Oncol. 2010;117(2):281-6.
  • Katepratoom C, Manchana T, Amornwichet N. Lower urinary tract dysfunction and quality of life in cervical cancer survivors after concurrent chemoradiation versus radical hysterectomy. Int Urogynecol J. 2014;25:91–6.
  • Donovan KA, Boyington AR, Judson PL, Wyman JF. Bladder and bowel symptoms in cervical and endometrial cancer survivors. Psychooncology. 2014;23(6):672-8.
  • Erekson EA, Sung VW, DiSilvestro PA, Myers DL. Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(2):159-63.
  • Bosch JL, Norton P, Jones JS. Should we screen for and treat lower urinary tract dysfunction after major pelvic surgery? ICI-RS 2011. Neurourol Urodyn. 2012;31(3):327-9.
  • Krhut J, Gärtner M, Mokris J, Horcicka L, Svabik K, Zachoval R, et al. Effect of severity of urinary incontinence on quality of life in women. Neurourol Urodyn. 2018;37(6):1925-30.
  • Lee YJ, Kim SR, Kim SK, Bai SW. The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study. Obstet Gynecol Sci. 2014;57(1):59-65.
  • Yen A, Tian Z, Hrycushko B, Albuquerque K. Risk factors for fistula formation after interstitial brachytherapy for locally advanced gynecological cancers involving vagina. J Contemp Brachytherapy. 2018;10(6):510-5.
  • Manchana T, Puangsricharoen P, Sirisabya N, Worasethsin P, Vasuratna A, Termrungruanglert W, et al. Comparison of Perioperative and Oncologic Outcomes with Laparotomy, and Laparoscopic or Robotic Surgery for Women with Endometrial Cancer. Asian Pac J Cancer Prev. 2015;16(13):5483-8.
  • Farquhar C, Brown PM, Furness S. Cost effectiveness of pre-operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy. BJOG. 2002;109(11):1273-80.
  • Kim HS, Kim K, Ryoo SB, Seo JH, Kim SY, Park JW, et al. Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis. J Gynecol Oncol. 2015;26(2):100-10.
  • Liu Y, Wang GC, Liu YJ, Wang YC, Chen XB, Luo YL, et al. Surgical concept and techniques of recurrent cervical cancer patients accompanied with high risk of intestinal obstruction after radical radiotherapy. Zhonghua Zhong Liu Za Zhi. 2020;42(1):61-4.
  • de Boer SM, Nout RA, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM, et al. Long-Term Impact of Endometrial Cancer Diagnosis and Treatment on Health-Related Quality of Life and Cancer Survivorship: Results From the Randomized PORTEC-2 Trial. Int J Radiat Oncol Biol Phys. 2015;93(4):797-809.
  • Pisani C, Deantonio L, Surico D, Brambilla M, Galla A, Ferrara E, et al. Quality of life in patients treated by adjuvant radiotherapy for endometrial and cervical cancers: correlation with dose-volume parameters. Clin Transl Oncol. 2016 Sep;18(9):901-8.
Year 2024, Volume: 41 Issue: 3, 510 - 514, 30.09.2024

Abstract

References

  • Fabian A, Krug D, Alkatout I. Radiotherapy and Its Intersections with Surgery in the Management of Localized Gynecological Malignancies: A Comprehensive Overview for Clinicians. J Clin Med. 2020;10(1):93.
  • Aue-Aungkul A, Kietpeerakool C, Rattanakanokchai S, Galaal K, Temtanakitpaisan T, Ngamjarus C, et al. Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer. Cochrane Database Syst Rev. 2021;1(1):CD012863.
  • Ziętek-Strobl A, Futyma K, Kuna-Broniowska I, Wojtaś M, Rechberger T. Urogynaecological Symptoms among Oncological Survivors and Impact of Oncological Treatment on Pelvic Floor Disorders and Lower Urinary Tract Symptoms. A Six-Month Follow-Up Study. J Clin Med. 2020; 30;9(9):2804.
  • Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS, et al. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 2009;103 Suppl 3:4-11.
  • Bruno V, Chiofalo B, Logoteta A, Brandolino G, Savone D, Russo M, et al. Urological Complications in Radical Surgery for Cervical Cancer: A Comparative Meta-Analysis before and after LACC Trial. Journal of Clinical Medicine. 2023; 12(17):5677.
  • Ramaseshan AS, Felton J, Roque D, Rao G, Shipper AG, Sanses TVD. Pelvic floor disorders in women with gynecologic malignancies: a systematic review. Int Urogynecol J. 2018;29(4):459-76.
  • Zwaans BMM, Lamb LE, Bartolone S, Nicolai HE, Chancellor MB, Klaudia SW. Cancer survivorship issues with radiation and hemorrhagic cystitis in gynecological malignancies. Int Urol Nephrol. 2018;50(10):1745-51.
  • Cho OH, Yoo YS, Kim JC, Park RH, Hwang KH. Factors Influencing Lower Urinary Tract Symptoms in Advanced Cancer Patients With Chemotherapy-Induced Peripheral Neuropathy. Int Neurourol J. 2018;22(3):192-9.
  • Chess-Williams R, McDermott C, Sellers DJ, West EG, Mills KA. Chronic psychological stress and lower urinary tract symptoms. Low Urin Tract Symptoms. 2021;13(4):414-24.
  • Helfand BT, Lee JY, Sharp V, Foster H, Naslund M, Williams OD, et al. Associations between improvements in lower urinary tract symptoms and sleep disturbance over time in the CAMUS trial. J Urol. 2012;188(6):2288-93.
  • Bristol Urological Institute, Internacional Consultation on Incontinence Modular Questionnaire (ICIQ). Available at. http://iciq.net. Accessed 28 Oct 2023.)
  • Gungor Uğurlucan F, Yasa C, Yuksel Ozgor B, Ayvacikli G, Gunaydin C, Balci BK, et al. Validation of the Turkish version of the ICIQ-FLUTS, ICIQ-FLUTS long-form, ICIQ-LUTS quality-of-life, and ICIQ-FLUTS sexual functions. Neurourol Urodyn. 2020;39(3):962-8.
  • Brown JS, Sawaya G, Thom DH, Grady D. Hysterectomy and urinary incontinence: a systematic review. Lancet. 2000;356(9229):535-9.
  • Keles E, Alınca CM, Ozturk UK, Oktay Korucuoglu F, Api M, Baydili KN. Quality of life, psychosocial distress in Gynecologic Oncology Patients: A Tertiary Center Experience. Kocaeli Medical Journal. 2023;12(1):14–23.
  • Oh JK, Choo MS, Lee J, Park NH, Oh SJ. Short-term effect of radical hysterectomy with or without adjuvant radiation therapy on urodynamic parameters in patients with uterine cervical cancer. Int Neurourol J. 2012;16:91–5.
  • Hazewinkel MH, Sprangers MA, van der Velden J, van der Vaart CH, Stalpers LJ, Burger MP, et al. Long-term cervical cancer survivors suffer from pelvic floor symptoms: a cross-sectional matched cohort study. Gynecol Oncol. 2010;117(2):281-6.
  • Katepratoom C, Manchana T, Amornwichet N. Lower urinary tract dysfunction and quality of life in cervical cancer survivors after concurrent chemoradiation versus radical hysterectomy. Int Urogynecol J. 2014;25:91–6.
  • Donovan KA, Boyington AR, Judson PL, Wyman JF. Bladder and bowel symptoms in cervical and endometrial cancer survivors. Psychooncology. 2014;23(6):672-8.
  • Erekson EA, Sung VW, DiSilvestro PA, Myers DL. Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(2):159-63.
  • Bosch JL, Norton P, Jones JS. Should we screen for and treat lower urinary tract dysfunction after major pelvic surgery? ICI-RS 2011. Neurourol Urodyn. 2012;31(3):327-9.
  • Krhut J, Gärtner M, Mokris J, Horcicka L, Svabik K, Zachoval R, et al. Effect of severity of urinary incontinence on quality of life in women. Neurourol Urodyn. 2018;37(6):1925-30.
  • Lee YJ, Kim SR, Kim SK, Bai SW. The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study. Obstet Gynecol Sci. 2014;57(1):59-65.
  • Yen A, Tian Z, Hrycushko B, Albuquerque K. Risk factors for fistula formation after interstitial brachytherapy for locally advanced gynecological cancers involving vagina. J Contemp Brachytherapy. 2018;10(6):510-5.
  • Manchana T, Puangsricharoen P, Sirisabya N, Worasethsin P, Vasuratna A, Termrungruanglert W, et al. Comparison of Perioperative and Oncologic Outcomes with Laparotomy, and Laparoscopic or Robotic Surgery for Women with Endometrial Cancer. Asian Pac J Cancer Prev. 2015;16(13):5483-8.
  • Farquhar C, Brown PM, Furness S. Cost effectiveness of pre-operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy. BJOG. 2002;109(11):1273-80.
  • Kim HS, Kim K, Ryoo SB, Seo JH, Kim SY, Park JW, et al. Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis. J Gynecol Oncol. 2015;26(2):100-10.
  • Liu Y, Wang GC, Liu YJ, Wang YC, Chen XB, Luo YL, et al. Surgical concept and techniques of recurrent cervical cancer patients accompanied with high risk of intestinal obstruction after radical radiotherapy. Zhonghua Zhong Liu Za Zhi. 2020;42(1):61-4.
  • de Boer SM, Nout RA, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM, et al. Long-Term Impact of Endometrial Cancer Diagnosis and Treatment on Health-Related Quality of Life and Cancer Survivorship: Results From the Randomized PORTEC-2 Trial. Int J Radiat Oncol Biol Phys. 2015;93(4):797-809.
  • Pisani C, Deantonio L, Surico D, Brambilla M, Galla A, Ferrara E, et al. Quality of life in patients treated by adjuvant radiotherapy for endometrial and cervical cancers: correlation with dose-volume parameters. Clin Transl Oncol. 2016 Sep;18(9):901-8.
There are 29 citations in total.

Details

Primary Language English
Subjects Gynecologic Oncology Surgery
Journal Section Research Article
Authors

Sahra Sultan Kara 0000-0001-5122-829X

Esra Keles 0000-0001-8099-8883

Emre Mat 0000-0002-3965-543X

Uğur Kemal Öztürk 0000-0003-0720-2919

İsmail Bağlar 0009-0008-0619-7111

Mustafa Maraşlı 0000-0002-5091-894X

Beyzanur Kahyaoğlu 0000-0002-4083-7636

Kursad Baydili 0000-0002-2785-0406

Meral Aban 0000-0002-0612-961X

Murat Api 0000-0001-9442-2690

Publication Date September 30, 2024
Submission Date February 21, 2024
Acceptance Date August 8, 2024
Published in Issue Year 2024 Volume: 41 Issue: 3

Cite

APA Kara, S. S., Keles, E., Mat, E., Öztürk, U. K., et al. (2024). The impact of radiotherapy on lower urinary tract symptoms in patients with gynecologic malignancies: a cross-sectional study. Journal of Experimental and Clinical Medicine, 41(3), 510-514.
AMA Kara SS, Keles E, Mat E, Öztürk UK, Bağlar İ, Maraşlı M, Kahyaoğlu B, Baydili K, Aban M, Api M. The impact of radiotherapy on lower urinary tract symptoms in patients with gynecologic malignancies: a cross-sectional study. J. Exp. Clin. Med. September 2024;41(3):510-514.
Chicago Kara, Sahra Sultan, Esra Keles, Emre Mat, Uğur Kemal Öztürk, İsmail Bağlar, Mustafa Maraşlı, Beyzanur Kahyaoğlu, Kursad Baydili, Meral Aban, and Murat Api. “The Impact of Radiotherapy on Lower Urinary Tract Symptoms in Patients With Gynecologic Malignancies: A Cross-Sectional Study”. Journal of Experimental and Clinical Medicine 41, no. 3 (September 2024): 510-14.
EndNote Kara SS, Keles E, Mat E, Öztürk UK, Bağlar İ, Maraşlı M, Kahyaoğlu B, Baydili K, Aban M, Api M (September 1, 2024) The impact of radiotherapy on lower urinary tract symptoms in patients with gynecologic malignancies: a cross-sectional study. Journal of Experimental and Clinical Medicine 41 3 510–514.
IEEE S. S. Kara, “The impact of radiotherapy on lower urinary tract symptoms in patients with gynecologic malignancies: a cross-sectional study”, J. Exp. Clin. Med., vol. 41, no. 3, pp. 510–514, 2024.
ISNAD Kara, Sahra Sultan et al. “The Impact of Radiotherapy on Lower Urinary Tract Symptoms in Patients With Gynecologic Malignancies: A Cross-Sectional Study”. Journal of Experimental and Clinical Medicine 41/3 (September 2024), 510-514.
JAMA Kara SS, Keles E, Mat E, Öztürk UK, Bağlar İ, Maraşlı M, Kahyaoğlu B, Baydili K, Aban M, Api M. The impact of radiotherapy on lower urinary tract symptoms in patients with gynecologic malignancies: a cross-sectional study. J. Exp. Clin. Med. 2024;41:510–514.
MLA Kara, Sahra Sultan et al. “The Impact of Radiotherapy on Lower Urinary Tract Symptoms in Patients With Gynecologic Malignancies: A Cross-Sectional Study”. Journal of Experimental and Clinical Medicine, vol. 41, no. 3, 2024, pp. 510-4.
Vancouver Kara SS, Keles E, Mat E, Öztürk UK, Bağlar İ, Maraşlı M, Kahyaoğlu B, Baydili K, Aban M, Api M. The impact of radiotherapy on lower urinary tract symptoms in patients with gynecologic malignancies: a cross-sectional study. J. Exp. Clin. Med. 2024;41(3):510-4.