Quantifying the impact of bladder complications following gynecological cancer treatment: systematic review and meta-regression
Gynecological cancer treatments, including radiotherapy (RT) and chemotherapy, leads to various bladder complications. The anatomical proximity of the treatment site to the urinary bladder primarily explains the complications following RT, while chemotherapy contribute to bladder dysfunction through systemic mechanisms. This study systematically reviews the nature, extent, and prevalence of bladder complications among women treated for these malignancies, underscoring the influence of treatment modalities on bladder function. A comprehensive search of databases including Embase, Scopus, PubMed/MEDLINE, CINAHL, and the Cochrane Library was conducted, focusing on women undergoing RT, chemotherapy, or both for gynecological cancers. Meta-regression was performed to quantify the effects of treatments on bladder function, using random-effect models. From 15,081 citations, 12 studies with a total of 12,469 participants were included. Our analysis revealed a broad spectrum of bladder complications, with urinary incontinence (UI) and overactive bladder symptoms being common, alongside with radiation cystitis and anatomical defects formation. The prevalence of these complications varied, reflecting the complexity of treatment modalities, cancer types, and patient characteristics. Specifically, UI rates ranged from 2.6% to 84%, while the incidence of fistula formation and ureteral stenosis remained relatively low but clinically significant. Urodynamic findings showed reduced bladder capacity and increased detrusor overactivity in up to 44% of evaluated patients, highlighting treatment's impact on bladder function. Bladder complications are prevalent among gynecological cancer survivors, with notable occurrences associated with chemotherapy and RT treatments. Integrated care focusing on both oncological and urological health is essential for enhancing survivors' quality of life. PROSPERO Identifier: CRD42023467123.