Genitourinary Radiation Injury: A Mixed-Methods Study Exploring Patient-Reported Outcomes and Impact on Quality of Life - 27/12/25

Doi : 10.1016/j.urology.2025.11.258

Lynn Leng ^a,^⁎ , Ankith Maremanda ^a , Kevin D. Li ^a,^b , William A. Pace ^a , John Myrga ^a , Adrian M. Fernandez ^a , Philip W. Chu ^a , Marvin N. Carlisle ^a , Behzad Abbasi ^a , Anna R. Faris ^a , Mikolaj Frankiewicz ^e , Nizar Hakam ^a , Alejandro Afanador ^a , Rachel Schwartz ^c,^d,^{^{1
Denotes Co-PI status and equal contribution as senior author.}} , Benjamin N. Breyer ^a,^b,^{^{1
Denotes Co-PI status and equal contribution as senior author.}}

^a Department of Urology, University of California, San Francisco, San Francisco, CA 94143

^b Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158

^c Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143

^d Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143

^e Medical University of Gdańsk, 80-210 Gdańsk, Poland

^⁎ Address correspondence to: Lynn Leng, M.S., University of California, San Francisco, 533 Parnassus Ave., San Francisco, CA 94143. University of California, San Francisco 533 Parnassus Ave San Francisco CA 94143

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 27 December 2025
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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.

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