Lower Urinary Tract Symptoms Are Underreported/Underdiagnosed in Gynecologic Cancer Survivorship

A poster presented at the 2026 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer demonstrated that lower urinary tract symptoms (LUTS) are underreported, underdiagnosed, and undertreated in gynecologic cancer survivorship.

Among patients who had a formal radiation cystitis diagnosis (n = 16), 87.5% (n = 14) received LUTS treatment and 56.3% (n = 9) received a referral to a urologic specialist. Though only 16 patients were diagnosed with radiation cystitis, investigators noted that 29 patients met radiation cystitis criteria. Of those who met the criteria, 65.5% (n = 19) received LUTS treatment and 44.8% (n = 13) received a referral to a urologic specialist.

Among patients who had 2 or more LUTS (n = 64), 57.8% (n = 37) received LUTS treatment and 29.7% (n = 19) received a referral to a urologic specialist (P ≤ .05). Among patients who had at least 2 LUTS without hematuria (n = 38), 44.7% (n = 17) of patients received LUTS treatment and 15.8% (n = 6) were referred to a urologic specialist (P ≤ .01).

“Individuals who experienced LUTS with or without hematuria without a formal diagnosis for radiation cystitis had decreased rates of treatment and referral to [urogynecology] and urologic specialties when compared with those formally diagnosed with radiation cystitis,” wrote presenting study author Caroline McElhannon, MD, a urogynecologist in the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham.

A total of 112 patients were included in this retrospective chart review. Patients who met the inclusion criteria were 18 years or older, underwent pelvic radiation involving brachytherapy for gynecologic malignancy, and received treatment at the University of Alabama at Birmingham from 2019 to 2021.

The objective of the review was to identify the rates of patient-reported LUTS, including dysuria, frequency, urgency, retention, nocturia, and pelvic pain. Other rates identified were hematuria and a formal diagnosis of radiation cystitis. Radiation cystitis was defined in the study as hematuria with LUTS.

The investigators hypothesized that radiation cystitis and LUTS were underdiagnosed and that this led to limited treatment or decreased specialist referral. They also stated that a lot of data that compared the effectiveness of treatments arose from studies within prostate cancer populations.

The mean age of patients in the trial was 55.8 years; 9.8% of patients were aged 18 to 39 years, 54% were aged 40 to 59 years, 43% were aged 60 to 79 years, and 3.6% were older than 80 years. The mean body mass index (BMI) of patients was 28.6; 7.1% of patients had a BMI less than 18.5, 27.6% had a BMI between 18.5 and 24.9, 29.5% had a BMI between 25 and 29.9, 17.0% had a BMI between 30 and 34.9, 6.3% had a BMI between 35 and 39.9, and 12.5% had a BMI of at least 40.

Additionally, 67.9% of patients were White, 22.3% were African American, 1.8% were Hispanic, and 8.0% were another race. The types of malignancy included were cervical (62.5%), vaginal (15.2%), endometrial (13.4%), vulvar (1.8%), ovarian (1.8%), and other malignancy (5.3%).

“LUTS are underreported, underdiagnosed, and undertreated in GYN [gynecological] cancer survivorship and present an opportunity for improvement and multidisciplinary care that could substantially contribute to quality of life in this understudied patient population,” wrote McElhannon and coauthors. “Future directions include expanding [the] database with additional years’ worth of data now available, consideration of more powerful prospective studies of treatment options, and consideration of [a] multidisciplinary survivorship clinic.”

Reference

McElhannon C, Powell TC, Donaldson K, Bansal A, Richter HE. Care of lower urinary tract symptoms after radiation for gynecologic cancer. Poster presented at: Society of Gynecologic Oncology 2026 Annual Meeting on Women’s Cancer; April 10-13, 2026; San Juan, PR. Poster 1438.