{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:46:27Z","timestamp":1790779587009,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the long\u2010term impact of endorectal balloon (ERB) use on rectal bleeding and endoscopic changes among patients who underwent symptom\u2010driven endoscopic evaluation after moderately hypofractionated intensity\u2010modulated radiotherapy (IMRT) for prostate cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>Between 2018 and 2020, 230 patients with prostate cancer underwent definitive moderately hypofractionated IMRT with or without ERB. Endoscopic assessment was performed based on gastrointestinal symptoms or clinical judgement. Rectal toxicity was assessed clinically and graded according to the Common Terminology Criteria for Adverse Events, while endoscopic findings were scored using the Vienna Rectoscopy Score (VRS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 5\u2010year cumulative incidence of Grade \u22652 rectal bleeding was 9.0% in the non\u2010ERB group and 27.7% in the ERB group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). In multivariable analysis, ERB use was independently associated with an increased risk of rectal bleeding (hazard ratio 3.45; 95% confidence interval 1.68\u20137.07;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), and this association was consistent across adjusted and matched cohorts. Endoscopic evaluation showed significantly higher rates of telangiectasia, mucosal congestion, and VRS \u22653 in the ERB group, particularly during the first 3\u2009years after radiotherapy. Temporal changes in VRS followed a quadratic trajectory, peaking at approximately 2\u20133\u2009years and subsequently declining. Oncological outcomes, including biochemical failure, distant progression, and overall survival, were comparable between the groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Endorectal balloon use during moderately hypofractionated IMRT was associated with significantly greater rectal bleeding, while oncological outcomes did not differ significantly. In the absence of demonstrated patient benefit, our findings do not support the routine use of ERB in contemporary prostate radiotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70175","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:16:51Z","timestamp":1770985011000},"page":"813-820","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk of rectal bleeding with endorectal balloon use after hypofractionated intensity\u2010modulated radiotherapy for prostate cancer"],"prefix":"10.1111","volume":"137","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3167-0635","authenticated-orcid":false,"given":"Jeong Yun","family":"Jang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Konkuk University Medical Center Konkuk University School of Medicine  Seoul Republic of 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