Urological complications after radiation therapy—nothing ventured, nothing gained: a Narrative Review

Radiation therapy along with chemotherapy and surgery are the three main treatment modalities used in oncology. The main disadvantage of radiotherapy is the fact that it affects both cancer and healthy cells located in the tumour area. As a consequence, different complications develop. A large proportion of cancers treated with radiotherapy are located in the lower abdomen and pelvis, which is why complications often involve the urinary tract. Due to the anatomy of these areas, urological complications occur not only after radiological treatment of urological cancers, but also after treatment of malignancies of the reproductive or digestive system. The most common radiation-induced complications include haemorrhagic cystitis, urethral and ureteral strictures, urinary fistulae, and secondary primary malignancies. Adverse events significantly degrade the quality of life of the patient, and in severe cases can be life threatening to the patient. Because of impaired tissue healing, the treatment of radiation urological complications is a challenge for urologists and often requires complicated reconstruction techniques. Continuous increase in the effectiveness of cancer treatments and the extension of patients’ lives, make complications of radiation therapy an increasingly common clinical problem. The aim of this review is to present the pathophysiology, clinical presentation and methods of treatment for radiation-induced urological complications.