title: Urinary diversions after radiation for prostate cancer: indications and treatment.
abstract: OBJECTIVE
  To characterize the presentation and symptom progression culminating in urinary diversion after radiotherapy for prostate cancer at a tertiary care reconstructive urology practice.
  
  
  METHODS
  Retrospective review of electronic medical records was performed for all patients between 2005 and 2011 who underwent urinary diversion for urologic complications of radiation therapy for treatment of prostate cancer. We analyzed demographics, type of radiation, presenting symptoms, diagnostic evaluation, and surgical interventions.
  
  
  RESULTS
  Of the 30 patients identified, 20% underwent external beam radiotherapy, 37% underwent brachytherapy, and 43% underwent combination therapy. Average time from radiation treatment until presentation to our institution was 4.6 years. Overall indications for urinary diversion included fistula (37%), end-stage bladder (20%), devastated outlet (27%), and a combination of end-stage bladder and devastated outlet (17%). Types of urinary diversion included cystectomy with conduit diversion, conduit diversion alone, and chronic indwelling suprapubic catheter. Eight patients additionally required bowel diversion for intractable gastrointestinal symptoms. Patients underwent an average of 4.4 procedures attempting to salvage native voiding function before urinary diversion.
  
  
  CONCLUSIONS
  The reported need for urinary diversion after radiation therapy for prostate cancer is rare and thus indications have not been well characterized. We found that all of our patients with rectourethral fistula had prior placement of brachytherapy seeds. External beam radiotherapy resulted in a higher incidence of end-stage bladder dysfunction, whereas brachytherapy seed placement was more commonly associated with a devastated outlet. Surgical management for end-stage disease included cystectomy with conduit diversion, conduit diversion alone, and indwelling suprapubic catheter.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: Sarah.fraumann@vanderbilt.edu.
authors.forename: Sarah Fraumann
authors.initials: SF
authors.lastname: Faris
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Milam
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Kaufman
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D015653:Cystectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011832:Radiation Injuries; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014547:Urinary Diversion