What is the treatment for chronic bladder wounds?

From the Guidelines

Treatment for chronic bladder wounds should prioritize a multifaceted approach, focusing on the underlying cause and severity, with initial management including antibiotics, pain management, and behavioral modifications, as well as potential surgical interventions, as recommended by recent guidelines 1.

Key Considerations

• Initial management includes antibiotics for infection, such as nitrofurantoin (100mg twice daily for 7-14 days) or trimethoprim-sulfamethoxazole (160/800mg twice daily for 7-14 days) 1.
• Pain management with medications like phenazopyridine (200mg three times daily) can provide relief from discomfort.
• Behavioral modifications are essential, including increased fluid intake (2-3 liters daily), avoiding bladder irritants (caffeine, alcohol, spicy foods), and scheduled voiding every 2-3 hours.

Surgical Interventions

• Surgical intervention, such as cystoscopy with fulguration or resection of ulcers, may be necessary for persistent wounds, with recent studies suggesting that laparoscopic ureteral repair is a viable option for intraoperatively detected injuries 1.
• The principles for a proper ureteric reconstruction include good vascular supply, adequate drainage, and a wide spatulated tension-free mucosa-to-mucosa anastomosis 1.

Recent Guidelines

• The 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries during emergency digestive surgery recommend immediate repair of IUTIs, with the role of the urologist in the operating room being fundamental when an IUTI is suspected 1.
• The guidelines also suggest that uncomplicated extraperitoneal injuries usually require non-operative management, consisting of bladder decompression with an indwelling urinary catheter and observation for at least 5 days 1.

From the Research

Treatment Options for Chronic Bladder Wounds

• Hyperbaric oxygen therapy has been used to treat radiation-induced hemorrhagic cystitis, a condition that can cause chronic bladder wounds, with some patients experiencing complete and durable resolution of symptoms 2.
• The treatment of chronic bladder wounds often requires a multidisciplinary approach, including the management of underlying conditions that may be contributing to the wound, such as diabetes or vascular impairment 3.
• In the case of radiation-induced cystitis, hyperbaric oxygen therapy has been shown to produce good short-term benefits, but may not always produce definitive long-term cure of the disease process 2.
• Other treatment options for chronic bladder wounds may include oral and intravesical medications, such as pentosan polysulfate and cyclosporine A, as well as surgical interventions, such as supravesical urinary diversion 2, 4.

Considerations for Treatment

• The treatment of chronic bladder wounds should be individualized to the patient's specific needs and underlying conditions 5.
• A thorough knowledge of tissue repair mechanisms at the cellular and molecular level can help guide treatment decisions and improve outcomes 5.
• The use of hyperbaric oxygen therapy has been shown to be effective in promoting wound healing in certain cases, including chronic vulvar wounds 3.

Challenges in Treatment

• The treatment of chronic bladder wounds can be challenging due to the complexity of the condition and the lack of standardized treatment protocols 4.
• There is limited evidence to support the use of specific treatments for chronic bladder wounds, and more research is needed to develop effective treatment strategies 4.
• The heterogeneity of symptoms, treatment modalities, and outcomes can make it difficult to compare results and develop definitive conclusions about the effectiveness of different treatments 4.