From the Guidelines
Radiation-induced cystitis should be managed with a stepwise approach, starting with conservative measures such as hydration, non-steroidal anti-inflammatory drugs, anticholinergic agents like oxybutynin, and analgesics like phenazopyridine, as recommended by the most recent guidelines 1. The initial workup for radiation-induced cystitis includes:
- Urine analysis to rule out infection
- Urine culture to identify any potential bacterial causes
- Assessment of symptoms, including dysuria, urinary frequency, nocturia, and hesitancy, which are associated with damage to the vasculature and vascular endothelial cell damage 1 Treatment options for radiation-induced cystitis are based on the severity of symptoms and may include:
- Conservative measures such as hydration and bladder analgesics
- Hyperbaric oxygen therapy to promote tissue healing through increased oxygenation
- Intravesical therapies like hyaluronic acid instillations or sodium pentosan polysulfate to restore the glycosaminoglycan layer
- For bleeding, options include intravesical alum irrigation, formalin instillation, or embolization of the internal iliac arteries in severe cases
- Surgical intervention with urinary diversion or cystectomy is reserved for refractory cases, as recommended by the guidelines 1 It is essential to note that radiation damage is progressive, and early intervention is crucial to prevent long-term complications such as fibrosis and decreased bladder capacity due to chronic inflammation and vascular damage from radiation-induced oxidative stress. The guidelines emphasize the importance of evaluating infection and primary bladder malignancy in patients with radiation-induced cystitis, and surgery should be considered in case of refractory disease 1.
From the Research
Workup for Radiation-Induced Cystitis
- The workup for radiation-induced cystitis typically involves assessing the severity of symptoms, such as hematuria, and evaluating the extent of bladder damage 2, 3.
- Cystoscopy with biopsy may be performed to confirm the diagnosis and rule out other conditions, such as recurrent malignancy 4.
- Imaging studies, such as CT scans or ultrasound, may also be used to evaluate the bladder and surrounding tissues 3.
Treatment Options for Radiation-Induced Cystitis
- Conservative management may include intravenous fluid replacement, blood transfusion, and transurethral catheterization with bladder washout and irrigation 3.
- Oral or parenteral agents, such as conjugated estrogens, pentosan polysulfate, or WF10, may be used to control hematuria 3.
- Intravesical instillation of agents, such as aluminum, placental extract, prostaglandins, or formalin, may also be effective in controlling symptoms 2, 3.
- Hyperbaric oxygen therapy (HBOT) has been shown to be effective in treating radiation-induced cystitis, with reported success rates ranging from 60% to 92% 3, 4, 5.
- Surgical options, such as urinary diversion or cystectomy, may be considered in severe cases or when other treatments have failed 2, 3.
Interventional and Surgical Treatments
- Cystoscopy with laser fulguration or electrocoagulation of bleeding points may be performed to control hematuria 3.
- Injection of botulinum toxin A into the bladder wall may relieve irritative bladder symptoms 3.
- Selective embolization or ligation of the internal iliac arteries may be considered in cases of severe bleeding 3.
- Surgical options, such as diversion ureterostomy or cystectomy, may be required in intractable cases 2.