Urologic effects of cancer treatment
Cancer treatment — particularly for prostate, bladder, colorectal, and gynecologic cancers — is highly effective at controlling disease. But surgery, radiation, and systemic therapies can cause significant urological complications that persist long after treatment ends. These complications are not inevitable, but when they occur they can be profoundly limiting — and they are often very treatable.
Dr. Wiegand's practice is built around exactly this population. Approximately half of his referrals come from outside the Orlando area specifically because of his expertise managing the aftermath of cancer treatment in the urinary tract.
Urinary Incontinence
After prostatectomy or radiation — ranging from mild leakage to complete loss of control. Managed with AMS 800, sling, or SNM.
Urethral & Bladder Neck Stricture
Scarring at the urethral anastomosis or bladder neck after prostatectomy or radiation — causing obstruction and difficulty voiding.
Ureteral Stricture
Narrowing of the ureter from radiation injury or surgical adhesions, threatening kidney function and drainage.
Radiation Cystitis
Bladder inflammation, hemorrhage, contracture, or fistula formation from pelvic radiation — from prostate, rectal, cervical, or bladder cancer treatment.
Urologic Fistulae
Abnormal connections between the bladder, urethra, vagina, or rectum — most commonly following radiation or combined surgical and radiation therapy.
Post-Cystectomy Reconstruction
Urinary reconstruction and surveillance after bladder removal for cancer, including complications from urinary diversion.
Why radiation injury is different
Radiation damage to the urinary tract is progressive and permanent. Unlike surgical complications that occur acutely and heal, radiation injury often worsens over years — as blood supply to the tissue is gradually compromised. This has critical implications for repair.
Standard repairs that work reliably in non-irradiated tissue frequently fail in the post-radiation environment. Successful surgery in radiated patients typically requires vascularized tissue interposition — bringing in healthy, non-irradiated tissue to support healing — and careful timing to allow the full extent of injury to declare itself before repair is attempted.
Hyperbaric oxygen therapy
In selected patients with radiation injury, hyperbaric oxygen therapy (HBO) may be used as an adjunct before and after surgical repair to improve tissue oxygenation and healing capacity. Dr. Wiegand coordinates with HBO programs when indicated.
Evaluation in the survivorship patient
Survivorship evaluation must account for both the specific urological complication and the full cancer treatment history — what was treated, how it was treated, and what the current disease status is. Reconstructive surgery is planned only after confirming there is no evidence of active or recurrent cancer at the site of proposed repair.
Treatment History Review
Complete review of cancer diagnosis, staging, treatment modalities (surgery, radiation type and dose, chemotherapy), and current oncologic status.
Oncologic Clearance
Confirmation of no active local recurrence or new disease at the reconstruction site — in coordination with the treating oncologist or urologist when needed.
Functional Urodynamic Studies
Assessment of bladder function, compliance, and sphincter integrity — essential for planning continence procedures in post-radiation patients.
Advanced Imaging
CT urogram, MRI pelvis, or retrograde/antegrade studies as indicated by the specific complication — stricture, fistula, or upper tract involvement.
What treatment looks like
Treatment is highly individualized and depends on the specific complication, the extent of radiation or surgical injury, and the patient's goals. Many survivorship patients have already been through extensive treatment — Dr. Wiegand approaches their care with particular attention to minimizing additional burden while achieving meaningful improvement in quality of life.
Common interventions include urethroplasty or endoscopic treatment for anastomotic stricture, AMS 800 or sling for post-prostatectomy incontinence, ureteral reconstruction for radiation-induced ureteral stricture, fistula repair, and bladder augmentation or diversion for radiation cystitis with contracture. Each of these is covered in detail on the relevant condition pages throughout this site.
You don't have to just live with it
Many survivorship patients are told their complications are an expected part of cancer treatment and cannot be improved. That is often not true. A consultation with a surgeon who specializes in this population is worth pursuing before accepting permanent limitation.
Dealing with the aftermath of cancer treatment?
Dr. Wiegand specializes in exactly this — restoring function and quality of life after the treatment that saved it. Request a consultation.
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