{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:45:32Z","timestamp":1790192732842,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,8,30]],"date-time":"2016-08-30T00:00:00Z","timestamp":1472515200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2017,5]]},"abstract":"\n Objective<\/jats:title>\n \n To describe the management of Radiation Therapy Oncology Group (\n RTOG<\/jats:styled-content>\n ) grade 4 urinary adverse events (\n UAE<\/jats:styled-content>\n s) after radiotherapy (\n RT<\/jats:styled-content>\n ) for prostate cancer (\n PC<\/jats:styled-content>\n a).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a single\u2010centre retrospective review, over a 6\u2010year period (2010\u20132015), to identify men with\n RTOG<\/jats:styled-content>\n grade 4\n UAE<\/jats:styled-content>\n s after\n RT<\/jats:styled-content>\n for\n PC<\/jats:styled-content>\n a.\n RT<\/jats:styled-content>\n was classified as combined therapy (radical prostatectomy [\n RP<\/jats:styled-content>\n ] followed by external beam radiotherapy [\n EBRT<\/jats:styled-content>\n ],\n EBRT<\/jats:styled-content>\n + low\u2010dose\u2010rate [\n LDR<\/jats:styled-content>\n ] brachytherapy,\n EBRT<\/jats:styled-content>\n + high\u2010dose\u2010rate [\n HDR<\/jats:styled-content>\n ] brachytherapy or other combinations of\n RT<\/jats:styled-content>\n ) or monotherapy\n RT<\/jats:styled-content>\n .\n UAE<\/jats:styled-content>\n s were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto\u2010urethral fistula) or bladder (contraction, necrosis, fistula, ureteric stricture or haemorrhage)\n UAE<\/jats:styled-content>\n s.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We identified 73 men with a mean age of 73 years. Of these, 44 (60%) received combined therapy, consisting of\n RP<\/jats:styled-content>\n +\n EBRT<\/jats:styled-content>\n (\n n<\/jats:italic>\n = 19),\n HDR<\/jats:styled-content>\n brachytherapy +\n EBRT<\/jats:styled-content>\n (\n n<\/jats:italic>\n = 19),\n LDR<\/jats:styled-content>\n brachytherapy +\n EBRT<\/jats:styled-content>\n (\n n<\/jats:italic>\n = 5), and other combined\n RT<\/jats:styled-content>\n (\n n<\/jats:italic>\n = 1). Twenty\u2010nine (40%) patients had monotherapy consisting of\n EBRT<\/jats:styled-content>\n (\n n<\/jats:italic>\n = 4),\n HDR<\/jats:styled-content>\n brachytherapy (\n n<\/jats:italic>\n = 11),\n LDR<\/jats:styled-content>\n brachytherapy (\n n<\/jats:italic>\n = 12), or proton beam therapy (\n n<\/jats:italic>\n = 2).\n UAE<\/jats:styled-content>\n s were isolated to the bladder in six men (8%), the outlet in 52 men (71%), and to both in 15 men (21%).\n UAE<\/jats:styled-content>\n management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion (\n UD<\/jats:styled-content>\n ) in 23 men (32%). Reconstruction included: ureteric (\n n<\/jats:italic>\n = 4), recto\u2010urethral fistula repair (\n n<\/jats:italic>\n = 2), and posterior urethroplasty (\n n<\/jats:italic>\n =13), of which 14\/16 surgeries (88%) with follow\u2010up >90 days were successful.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Although the incidence of\n RTOG<\/jats:styled-content>\n grade 4\n UAE<\/jats:styled-content>\n s after\n PC<\/jats:styled-content>\n a radiation treatment is not well defined, their associated morbidity is significant, and approximately one third of patients with these high\u2010grade complications require\n UD<\/jats:styled-content>\n . Conversely, only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bju.13607","type":"journal-article","created":{"date-parts":[[2016,8,30]],"date-time":"2016-08-30T04:16:07Z","timestamp":1472530567000},"page":"700-708","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Management of Radiation Therapy Oncology Group grade 4 urinary adverse events after radiotherapy for prostate cancer"],"prefix":"10.1111","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3149-7139","authenticated-orcid":false,"given":"Erik N.","family":"Mayer","sequence":"first","affiliation":[{"name":"Department of Surgery Center for Reconstructive Urology and Huntsman Cancer Institute University of Utah Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Tward","sequence":"additional","affiliation":[{"name":"Department of Surgery Center for 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