A Novel Approach for the Treatment of Radiation-Induced Hemorrhagic Cystitis with the GreenLight^™ XPS Laser

Abstract

Introduction:The treatment of pelvic malignancies with radiotherapy can develop severe sequelae, especially radiation-induced hemorrhagic cystitis. It is a progressive disease that can lead to the need for blood transfusion, hospitalizations, and surgical interventions. This tends to affect the quality of life of these patients, and management can at times be difficult. We have evaluated the GreenLight Xcelerated Performance System (XPS) with TruCoag, although primarily used for management of benign prostatic hypertrophy (BPH), for the treatment of radiation-induced hemorrhagic cystitis.Materials and Methods:After International Review Board (IRB) approval, a retrospective chart review was performed in addition to a literature search. A series of four male patients, mean age of 81 years, with radiation-induced hemorrhagic cystitis secondary to radiotherapy for pelvic malignancies (3 prostate cancer, 1 rectal cancer) were successfully treated with the GreenLight laser after unsuccessful treatment with current therapies described in the literature.Results:All four patients treated with the GreenLight laser had resolution of their hematuria after one treatment and were discharge from the hospital with clear urine.Conclusion:The GreenLight XPS laser shows promising results for the treatment of patients with radiation-induced hemorrhagic cystitis, and deserves further evaluation and validation, especially since there is limited data available in the literature regarding the use of this technology for the treatment of this devastating condition.

A Narrative Review on the Pathophysiology and Management for Radiation Cystitis

“…Two small case series of patients with radiation-induced haemorrhagic cystitis report clearance of haematuria after one treatment with the GreenLight Xcelerated Performance System (XPS) or GreenLight potassium-titanyl-phosphate (KTP) laser [ 52 , 53 ]. A second case series of twenty patients undergoing endoscopic treatment with the GreenLight KTP laser reported a 92.3% rate of resolution of haematuria, although 25% of patients required multiple treatments.…”

Hyberbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis

“…More than a decade ago, a Cochrane Database systematic literature review on non-surgical interventions for late radiation cystitis in patients who underwent radical radiotherapy to the pelvis concluded that in the absence of randomized controlled studies it is impossible to set definitive rules for treatment ( 5 ). Recently, there have been reports of KTP laser use in an attempt of haemostasis with minimal mucosal destruction with promising results as a final step before definitive treatment ( 18 , 19 ). In case of intractable haemorrhage, arterial embolization or ligation and/or cystectomy represent definitive treatment, at the cost of increased morbidity.…”

Chronic Inflammation and Radiation-Induced Cystitis: Molecular Background and Therapeutic Perspectives

“…If acute active bleeding does persist and is refractory to irrigations, electrocoagulation should be discussed, as described by Martinez and colleagues [ 18 ]. The procedure was performed with a rigid 22 French cystoscope.…”

“…Very minimal bladder mucosal damage was reported. Then, a large three-way catheter was placed, and continuous irrigation was maintained overnight and stopped the next morning [ 18 ].…”