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PD11-04 SARCOPENIA IN PELVIC RADIATION DISEASE IS NEARLY UNIVERSAL AND AN INDEPENDENT RISK FACTOR FOR LATE URINARY DIVERSION COMPLICATIONS
Abstract   Peer reviewed

PD11-04 SARCOPENIA IN PELVIC RADIATION DISEASE IS NEARLY UNIVERSAL AND AN INDEPENDENT RISK FACTOR FOR LATE URINARY DIVERSION COMPLICATIONS

Timothy W. Hays, Sydney K. Houlton and Bradley A. Erickson
The Journal of urology, Vol.215(5S), p.e633
05/2026
DOI: 10.1097/01.JU.0001191452.55243.54.04

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Abstract

INTRODUCTION AND OBJECTIVES: Severe pelvic radiation (XRT) disease (PRD) secondary to prostate cancer treatment can result in the need for cystectomy and urinary diversion – a procedure with a historically high complication rate. We sought to determine how pre-operative skeletal muscle mass relates to surgical outcomes. METHODS: A 15-year retrospective review of men undergoing cystectomy and diversion for PRD was performed. Skeletal muscle mass was calculated by reviewing the pre-operative CT scan for psoas muscle thickness per height (PMTH; mm/m) with male sarcopenia being defined as a PMTH < 17.3 per guidelines. Outcomes of interest included 30-day and late (>30 day) complications. Radiation, patient and surgical variables were analyzed for their relationship to outcomes. RESULTS: The cohort included 59 men aged 70.8±6.6. XRT was primary (n=11), adjuvant(n=17), and salvage(n=31). Mean time from XRT to development of PRD was 5.2±5.0 years and mean time from PRD to cystectomy was an additional 3.2±4.1 years. Surgery included cystectomy (n=46) and cystoprostatectomy (n=13) with ileal (n=52) or colon (n=7) conduit. Mean PMTH was 12.1±2.0 with 96.6% (n=57) meeting the definition for sarcopenia (Figure 1). Early complications occurred in 50% (n=30) with 22% (n=13) being Clavien-Dindo 3. Late complications occurred in 67% (n=40) with 27% (n=16) being Clavien-Dindo 3-5 (Figure 2). Controlling for age and radiation dose, predictors of early complications included only active androgen deprivation therapy (OR: 7.6, 95% CI 1.2–47; p=0.03). For late complications, lower PMTH was associated with increased risk (OR per 1 mm/m increase: 0.66, 95% CI 0.45–0.97; p=0.03). CONCLUSIONS: Nearly all men with PRD undergoing cystectomy have sarcopenia – and in this cohort, lower PMTH was associated with severe long-term complications after cystectomy. How the length of time with PRD (nearly three years in this cohort) before major surgery affects PMTH and the potential role for aggressive prehabilitation deserves further study in the growing population of patients.

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