Lower urinary tract function after intra-arterial chemotherapy with concurrent pelvic radiotherapy for invasive bladder cancer

Background: Intra-arterial chemotherapy with concurrent pelvic radiotherapy as a bladder-sparing regimen for invasive bladder cancer is highly promisi ng for selected patients. However, lower urinary tract function after this treatment has not been fully investigated. Methods: The urodynamic effects of intra-arterial chemothrapy with concurre nt pelvic radiotherapy were retrospectively evaluated in 14 patients with o rgan-confined invasive bladder cancer. The post-treatment urodynamic findin gs were compared with the pretreatment ones (n = 7), and a comparison was m ade between the serial urodynamic findings after the treatment in another s even patients who were able to undergo the pretreatment urodynamic study (U DS). Results: The median follow-up period up to the latest UDS was 34 months. Of the 14 patients, the latest UDS revealed some storage dysfunctions in 11 ( 79%) and some emptying dysfunctions in three (23%). Uninhibited detrusor co ntraction and decreased bladder compliance were recorded in 29 and 43% at t he pretreatment UDS and approximately 50-60 and 20-60% in the serial follow -up studies, respectively (n = 7). Impaired detrusor contractility lasted i n one patient. In the seven patients without the pretreatment UDS, decrease d maximum cystometric capacity and decreased compliance were recorded in ap proximately 50-60 and 20-60% at the serial UDS, respectively. Detrusor cont ractility was aggravated in one patient and completely lost in one with tim e. Conclusions: The urodynamic findings indicate that the bladder-sparing regi men might result in perpetuating the lower urinary tract dysfunctions due t o invasive bladder cancer itself and/or transurethral surgery and might inj ure the infrasacral autonomic nerves and the bladder itself.