Genitourinary Radiation Injury: A Mixed-Methods Study Exploring Patient-Reported Outcomes and Impact on Quality of Life

urologyxy
Jan 3
2 min read

ABSTRACT

Objective

To assess the long-term outcomes and lived experiences of patients with genitourinary radiation injuries following prostate cancer radiation therapy.

Materials and Methods

This mixed-methods study included twenty patients recruited from a high-volume reconstructive urology practice from 2023 to 2025. Participants completed International Prostate Symptom Score (IPSS) and Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfactions (PROMIS SexFs) surveys assessing lower urinary tract symptoms (LUTS) and sexual function, followed by semi-structured interviews. Following an inductive thematic analysis approach, coders reviewed the transcripts, developed a codebook, and identified salient themes using Dedoose (V.10.0.25).

Results

Among 20 patients, 8 underwent external beam radiation therapy, 6 brachytherapy, and 6 intensity-modulated radiation therapy. Primary complications included incontinence (40%), urethral stricture (30%), LUTS (15%), and hemorrhagic cystitis (15%). Median scores for IPSS and PROMIS SexFS were 12 and 34.1, respectively, which correspond to moderate LUTS and decreased sexual function and satisfaction. Thematic analysis identified 15 subthemes related to healthcare access, pre-radiation therapy (XRT) counseling, physical and psychosocial changes, and support systems. Participants desired transparent, compassionate counseling and access to tertiary care. After injury, patients described loss of bodily control, sleep disturbance, and sexual dysfunction, and the importance of social support and reframing perspective.

Conclusion

Patients with genitourinary radiation injury reported profound quality-of-life disruptions and highlighted the value of transparent counseling, strong support networks, and resiliency. Urologists and radiation oncologists should consider increased risk-benefit discussions prior to XRT and promote structured peer support networks.

Prostate cancer remains the most common non-cutaneous cancer among men, with radiation therapy (XRT) serving as a mainstay treatment for both localized and advanced disease. Despite advancements in XRT techniques, the long-term impacts and progression of radiation injury continue to present significant challenges for prostate cancer survivors and are not fully understood.^1,2

Radiation injury is a condition resulting from ionizing radiation exposure that may manifest as tissue damage and functional impairment of affected areas. The extent of radiation injury can vary depending on radiation modality, dose, duration of exposure, and the tissues involved.³ Patients commonly exhibit substantial urinary and sexual concerns, attributed to chronic urogenital inflammation and lower urinary tract symptoms (LUTS), and more rarely, life-threatening conditions, like bladder cancer.^4,5 A large Medicare-based cohort study found that men treated with XRT had more than twice the risk of genitourinary toxicity compared with surgery, with nearly 1 in 5 experiencing toxicity within 10 years.⁵ With the increasing use of XRT in urologic cancers to treat, cure, and prolong patient survival, the long-term progression of XRT toxicity represents an underrecognized concern that has profound impacts on patient quality of life (QOL).^6,7 It is critical to study a focused cohort to understand the effects of XRT toxicity from a patient-centered perspective.

Currently, the few studies that examine the sequelae of radiation injury rely on quantitative, patient-reported outcome measures. This mixed-methods study combines the use of validated instruments and semi-structured interviews to comprehensively examine the lived experience of radiation injury on various aspects, including tissue function, QOL, emotional well-being, and self-perception, with the goal of ultimately improving medical care and support for affected individuals.