Frequency of urogynecological complications after pelvic radiotherapy

Pelvic radiotherapy is an integral part of treatment of many gynecological and other pelvic malignancies; however, it is associated with a risk of late urogynecological complications that can significantly affect the patients' quality of life. The most common problems include lower urinary tract symptoms, particularly urgency, urinary incontinence, and radiation cystitis, as well as vaginal stenosis, dryness, dyspareunia, lymphedema, and chronic pelvic pain. The incidence of these complications depends on the total radiation dose, radiotherapy technique used, combination with surgical treatment or brachytherapy, and individual patient-related risk factors. The underlying pathophysiology involves post-radiation inflammatory and fibrotic changes, vascular damage, and impaired innervation of irradiated tissues. Diagnosis requires long-term follow-up, targeted medical history taking, physical examination, and the use of functional and imaging methods. Prevention and management are based on modern radiotherapy techniques, patient education, conservative and pharmacological approaches, physiotherapy, and in selected cases, surgical treatment. An essential component of care is also addressing psychosocial consequences, which significantly affect sexuality, partner relationships, and psychological well-being.