From the Guidelines
Radiation-induced urethritis is best managed with a combination of supportive care and targeted treatments, prioritizing patient comfort and minimizing complications. For immediate relief, I recommend using phenazopyridine (Pyridium) 200mg three times daily for 2-3 days to reduce urinary pain and burning, as this medication provides a local anesthetic effect on the urethral mucosa 1. Additionally, patients should increase fluid intake to 2-3 liters daily to dilute urine and reduce irritation. Sitz baths for 10-15 minutes, 2-3 times daily using warm water can soothe inflammation. For persistent symptoms, topical lidocaine gel 2% applied to the urethral meatus before urination can provide temporary relief. Anti-inflammatory medications like ibuprofen 400-600mg every 6-8 hours can help reduce inflammation and discomfort. Patients should avoid potential irritants such as caffeine, alcohol, spicy foods, and acidic beverages during the healing period. If symptoms persist beyond 2 weeks or worsen, further evaluation is necessary to rule out secondary infection or more severe radiation damage, as noted in the American Cancer Society guideline for the early detection of prostate cancer 1.
Key Considerations
- Radiation-induced urethritis occurs because ionizing radiation damages the rapidly dividing epithelial cells lining the urethra, leading to inflammation, mucosal breakdown, and subsequent symptoms of pain, frequency, and dysuria.
- Most cases improve within 1-2 weeks after radiation treatment ends as the urethral tissue begins to heal.
- The management of radiation-induced urethritis focuses on alleviating symptoms and preventing complications, rather than curing the condition.
- The evidence from the American Cancer Society guideline 1 and other studies emphasizes the importance of supportive care and targeted treatments in managing radiation-induced urethritis.
Treatment Options
- Phenazopyridine (Pyridium) 200mg three times daily for 2-3 days
- Increased fluid intake to 2-3 liters daily
- Sitz baths for 10-15 minutes, 2-3 times daily using warm water
- Topical lidocaine gel 2% applied to the urethral meatus before urination
- Anti-inflammatory medications like ibuprofen 400-600mg every 6-8 hours
Important Notes
- Patients should avoid potential irritants such as caffeine, alcohol, spicy foods, and acidic beverages during the healing period.
- If symptoms persist beyond 2 weeks or worsen, further evaluation is necessary to rule out secondary infection or more severe radiation damage.
- The study by the American Cancer Society 1 provides the most recent and highest quality evidence for the management of radiation-induced urethritis.
From the Research
Diagnosis of Radiation-Induced Urethritis
- Radiation-induced urethral stricture occurs most often due to radiation for prostate cancer, with stricture rates varying depending on the type of radiation therapy used 2
- Diagnostic work-up for radiation-induced urethral stricture should include basic urologic work-up, ultrasound, uroflowmetric assessment, urethroscopy, retrograde urethrogram, and voiding cystourethrography 2
Treatment of Radiation-Induced Urethritis
- Treatment of radiation-induced urethritis (inflammation-predominant) should be symptomatic, based on the existence of bothersome storage or voiding lower urinary tract symptoms as well as on pain 3
- For bleeding-predominant radiation-induced urethritis, hydration and hyperbaric oxygen therapy (HOT) should be used first, followed by oral drugs if HOT is not available 3
- Focal therapy of bleeding vessels with a laser or electrocoagulation is indicated if local bleeding persists, while intravesical installation should be initiated in case of generalized bleeding 3
- Urethroplasty is a feasible option for patients with radiation-induced urethral stricture, with excision and primary anastomosis being the preferred technique 4, 5
- Patients with radiation-induced urethral stricture should be counseled on the potential for urinary incontinence following urethroplasty, with success rates of primary end-to-end anastomosis (EPA) and buccal mucosa graft urethroplasty (BMGU) ranging from 70-95% and 71-78%, respectively 2, 5
Management of Radiation-Induced Urethral Stricture
- Endoscopic management such as dilatation and internal urethrotomy has been proposed for short strictures, but has a high risk of recurrence 2
- Urethroplasty has an acceptable success rate with durable outcomes, but is technically challenging due to stricture location and tissue damage 5
- Postoperative incontinence can be successfully treated with an artificial urinary sphincter 2