Long-term complications
Complication	Likelihood	Time frame	Detail
Fistula	Occurs in up to 8.8% of surgically treated patients. Rate is highest in patients with prior irradiation.	Variable	One-third to one-half will heal spontaneously. The remainder will require a reparative procedure such as ureteroneocystostomy.
Intestinal obstruction	5–15% in patients treated with radiation therapy.	Variable, up to years	Generally the result of fibrosis and ischemia secondary to the effect of radiation therapy on small blood vessels and connective tissue. Conservative management includes bowel rest, decompression, and diet modification. Refractory cases may require surgery.
Urinary urgency, incontinence, and frequency	26% incidence in patients treated with radiation alone.	Variable	Same dysfunction noted in about 10% of the general female population and incidence is higher in older women.
Sexual dysfunction	Not determined.	Variable	Surgery will shorten the functional length of the vagina, but pliability and lubrication are often preserved. Radiation therapy can reduce length, caliber, and lubrication. These symptoms can be alleviated in some patients by hormonal therapy, vaginal dilators, and lubricants.