Acute and late adverse events of HDR brachytherapy

4.3.1. Urinary toxicity

Acute urinary symptoms such as urinary urgency and frequency are common and usually resolve within a few months. Urinary retention occurs in less than 5% of patients treated with combination of HDR brachytherapy and EBRT [89, 94, 104, 105]. Urinary strictures are reported in up to 15% of patients, and most commonly seen in the bulbomembranous urethra [106, 107]. Urinary incontinence is extremely rare, and seen in less than 2% of patients [107, 108].

4.3.2. Rectal toxicity

Transient rectal symptoms such as rectal urgency or frequency often occur. Late rectal bleeding may occur and is usually not clinically significant. Rectal fistula is extremely rare, and seen in less than 1% of patients[89].

4.3.3. Sexual toxicity

Erectile dysfunction has been reported in up to 40% of patients, but approximately 80% will respond to phosphodiesterase-5 inhibitors (86).

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