Prevalence of Pelvic Floor Dysfunction in Women After Pelvic Radiotherapy: Systematic Review and Meta-Analysis

Survivors of pelvic cancer are at risk for pelvic floor dysfunction (PFD). This review is aimed at determining the pooled prevalence of PFD after pelvic radiotherapy and explore associations with treatment modalities.

We included observational studies of women with urogynecological or anorectal cancer treated with radiotherapy, brachytherapy, or chemoradiotherapy, assessing PFD. Exclusion criteria were previous pelvic surgery or rehabilitation, reviews, case reports, conference abstracts, comments, letters, or inaccessible full texts. We searched PubMed, PubMed PMC, Cochrane library, EMBASE, Web of Science, and Scopus to 6 August 2024. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Meta-analyses were conducted in R software. Meta-regression explored potential covariates. A 5% level of statistical significance was established.

Fifteen studies involving 1667 women were included. Pooled prevalence estimates were urinary incontinence (UI, 37%), stress UI (34%) and urgency UI (47%), overactive bladder (42%), anal incontinence (24%), defecatory urgency (20%), pelvic pain (30%), and sexual dysfunction (19%). Longer follow-up time was associated with increased defecatory urgency (p = 0.0054). Certainty of evidence was moderate for urgency urinary incontinence and overactive bladder, and low for the other outcomes. No publication bias was detected (Egger's test, p = 0.17).

Radiotherapy for pelvic malignancies is associated with UI and overactive bladder symptoms. Bowel and sexual dysfunction were heterogeneous, but defecatory urgency increased over time. Limitations include heterogeneity in follow-up and study methods. Routine assessment and proactive multidisciplinary care are needed to mitigate morbidity and improve quality of life.