Genitourinary Radiation Injury: A Mixed-methods Study Exploring Patient-reported Outcomes and Impact on Quality of...

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

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).

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.

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.