Radiation therapy for treatment of various pelvic cancers in both genders is being widely utilized. With improved survivorship, a significant number of these patients experience genitourinary toxicity which more commonly manifests as radiation cystitis/visible haematuria. However, non-haematuria symptoms of toxicity are often overlooked and are difficult to manage. We aimed to investigate the incidence of non-haematuria genito-urinary toxicity symptoms in patients presenting to our specialist radiation cystitis service and analyse if these were more prevalent in specific treatment groups.

We analysed our prospectively maintained specialist radiation cystitis clinic database for patients treated at our centre between January 2016-Sept 2024. Demographic data was collated and additional information on non-haematuria related symptoms were collected from patient charts. Data was analysed using SPSS 29.

219 patients were identified for analysis. 169 (77%) were male with a median age of 72 (Range 26-96). The mean time from radiation treatment to symptoms of genitourinary toxicity was 3 years (Range <1 year to 17 years). The primary diagnosis for radiation treatment were bladder cancer 13 (6%), prostate cancer 157 (72%), colorectal cancer 4 (2%), cervical cancer 36 (16%) and endometrial cancer 9 (4%). Non-haematuria symptoms were highly prevalent in this patient cohort. Symptoms included incontinence (54.3%), urinary tract infections (21.9%), chronic pelvic pain (32.4%), concurrent bowel symptoms (24.2%), hydronephrosis (14%), urethral strictures (9.1%) and fistulas (7.3%). Chronic pelvic pain was more prevalent in patients undergoing radiotherapy for cervical cancer than all other cancers (58% vs. 27%, p<0.002). There were no other differences in the incidence of these symptoms between the different cancer groups. Sub-analysis of the patients with prostate cancer showed no difference in the incidence of non-haematuria genitourinary toxicity in between patients undergoing brachytherapy, primary external beam radiotherapy or adjuvant/salvage radiotherapy. 17 of these patients ultimately required salvage cystectomy for non-haematuria genitourinary toxicity indications.

Non-haematuria symptoms are very common in patients suffering from genitourinary toxicity from radiotherapy. Addressing these in conjunction with treatment for visible haematuria is important in providing patients with improved quality of life. Of particular concern is the high rates of chronic pain in patients undergoing radiation treatment for cervical cancer as these patients are often much younger resulting in significant quality of life reduction for these patients.