What are the treatment options for radiation-induced cystitis (inflammatory bladder condition caused by radiation therapy)?

From the Guidelines

Treatment for radiation cystitis should prioritize a multi-faceted approach, focusing on symptom severity, and may include conservative measures, medication, hyperbaric oxygen therapy, intravesical treatments, and surgical interventions as necessary. For mild cases, conservative measures such as increased hydration and avoiding bladder irritants can be effective 1. Medication options include non-steroidal anti-inflammatory drugs, anticholinergic agents like oxybutynin, or analgesics such as phenazopyridine 1.

Some key considerations for treatment include:

• Managing acute symptoms with urine analysis and urine culture 1
• Using botulinum toxin A injection into the detrusor muscle when drug therapy is ineffective 1
• Considering hydration, hyperbaric oxygen, clot evacuation, endoscopic fulguration, and bladder irrigation for hemorrhagic cystitis 1
• Evaluating surgery in case of refractory disease, and ruling out infection and primary bladder malignancy 1

For more severe cases, hyperbaric oxygen therapy and intravesical treatments like hyaluronic acid or chondroitin sulfate instillation may be beneficial 1. It's essential to note that radiation cystitis occurs due to damage to the blood vessels in the bladder wall, leading to inflammation, reduced blood supply, and eventual tissue fibrosis, which is why treatments focus on reducing inflammation, protecting the bladder lining, and promoting tissue healing 1.

Key factors influencing treatment decisions include:

• Symptom severity and impact on quality of life
• Presence of complications such as bleeding or infection
• Patient's overall health and ability to tolerate different treatments
• Need for prompt intervention to prevent long-term damage and improve outcomes 1

From the Research

Treatment Options for Radiation Cystitis

• Initial management includes intravenous fluid replacement, blood transfusion if indicated, and transurethral catheterization with bladder washout and irrigation 2
• Oral or parenteral agents that can be used to control hematuria include conjugated estrogens, pentosan polysulfate, or WF10 2
• Cystoscopy with laser fulguration or electrocoagulation of bleeding points is sometimes effective 2
• Injection of botulinum toxin A in the bladder wall may relieve irritative bladder symptoms 2
• Intravesical instillation of aluminum, placental extract, prostaglandins, or formalin can also be effective 2

Hyperbaric Oxygen Therapy (HBOT)

• HBOT involves the administration of 100% oxygen at higher than atmospheric pressure 2, 3
• The reported success rate of HBOT for radiation cystitis varies from 60% to 92% 2
• A study found that HBOT had a success rate of 92.4% in controlling hematuria, with a median follow-up period of 63 months 3
• The study also found that the sooner HBOT is delivered after the first episode of hematuria, the better the response rates and lower recurrences concerning hematuria 3

Medical Therapies

• Sodium pentosan polysulfate (SPP) is a primary method of managing hemorrhagic cystitis associated with pelvic radiotherapy or systemic chemotherapy 4
• A study found that SPP was effective in managing hemorrhagic cystitis, with a median duration of treatment of 180 days and a median follow-up period of 450 days 4
• Other medical therapies, such as conjugated estrogens and WF10, can also be used to control hematuria 2, 5

Surgical Options

• Surgical options include urinary diversion by percutaneous nephrostomy or intestinal conduit, with or without cystectomy 2
• These options are typically considered for patients who have failed conservative management or have severe, life-threatening hemorrhage 2, 5