Long-term urological complications after conservative local treatment
(surgery and brachytherapy) in children with bladder-prostate
rhabdomyosarcoma. A single team experience.
Background: Outcome of children with bladder-prostate rhabdomyosarcoma
has improved with multimodal therapies, including surgery and/or
radiotherapy for local treatment. Our aim was to report the long-term
urological complications after a conservative approach combining
conservative surgery and brachytherapy. Patients and methods: Eighty-six
patients, free of disease, were retrospectively reviewed. Symptoms
related to urinary tract obstruction, incontinence, infection and
lithiasis were reported and graded according to CTCAE classification.
Only symptomatic patients underwent urodynamic studies. Risk factors for
complications were analyzed. Results: There were 76 males and 10
females. The median follow-up was 6.3 years (18 months-24 years).
Complications occurred after a median follow up 5 years (0-21).
Twenty-two patients had long-term urological complications. Urinary
tract obstruction was found in 15 patients, urinary incontinence in 14
patients. Recurrent urinary tract infection and urinary lithiasis were
found in 5 patients respectively. Beyond symptom, 3 etiologies were
identified: bladder dysfunction in 15 patients, urethral stenosis in 6
and uretero-vesical junction stenosis in 5. Posterior bladder wall
dissection used in large prostatic tumors, operation at age less than 2
years and partial prostatectomy were identified as risk factors for
these complications. Conclusion: The conservative surgical approach
combined with brachytherapy for BPRMS leads to long-term urological
complications in 22% of patients free of their disease. Optimizing
brachytherapy doses for young children and establishing a clear and long
term follow-up protocol, could help to reduce these complications.