Abstract
OBJECTIVES:The purpose of this study was to evaluate the incidence of urinary tract infection (UTI) in patients with cystitis symptoms who underwent pelvic radiation therapy and identify correlated predictive factors.METHODS:A prospective cohort study was conducted of patients who met the following: primary pelvic cancer treated with curative intent, older than 18 years old, and good performance status. The exclusion criteria were patients being treated for a UTI, using a urinary catheter, in dialysis or with cystostomy or nephrostomy, and using antibiotics during treatment. Urinalysis and urine culture were collected before the beginning of radiation therapy. Weekly evaluations of urinary symptoms were subsequently performed. In cases of new or worsening symptoms, a questionnaire was applied, and new urine exams were collected. The UTI diagnosis was defined by uroculture as bacterial growth greater than 104 CFU/mL.RESULTS:From September 2014 to November 2015, 112 patients were sequentially recruited, and 72 (64%) fulfilled the inclusion criteria. During follow-up, 24 (33%) patients had new urinary symptoms or worse preexisting symptoms. A UTI was confirmed in the second urinary culture in only one (1.4%) patient.CONCLUSIONS:The incidence of UTI was much lower than expected, suggesting that asymptomatic bacteriuria develops symptoms due to radiotherapy. Due to the low rate of UTI, no predictive factor was identified.
Highlights
The urinary bladder is frequently exposed, partially or entirely, during radiation therapy for pelvic tumors
The specific protocol of the study included an evaluation of the main urinary symptoms related to the treatment, which were graded according to Radiation Therapy Oncology Group (RTOG) scores [14]
Due to the lower than expected incidence of symptomatic patients and especially the low incidence of urinary tract infection (UTI) found in the study, which was much lower than that used for the sample calculation, patient recruitment was interrupted, and the initially proposed regression analysis of UTI-predictive factors was aborted
Summary
The urinary bladder is frequently exposed, partially or entirely, during radiation therapy for pelvic tumors. Due to the effect of radiation on epithelial cells, acute functional alterations, including increased urinary frequency, dysuria and hematuria, can occur and may mimic the secondary symptoms of urinary tract infection (UTI) [1]. Received for publication on June 24, 2019. Accepted for publication on September 24, 2019
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