Current management of radiation cystitis: a review and practical guide to clinical management

Abstract

With evaluation of existing literature, this narrative review also provides a stepwise clinical algorithm to aid the urologist in treating patients presenting with complications associated with radiation cystitis.

Pre-clinical Research on Bladder Toxicity After Radiotherapy for Pelvic Cancers: State-of-the Art and Challenges

“…Moreover, histopathological changes in the human irradiated bladder have also been divided into "early" (predominant <12 months after irradiation) and "late" (predominant >12 months after irradiation) changes, consistent with the proposed model of RC progression in the animal model (52,93). However, there are some subtle differences: for example, fibrosis has seldom been reported in humans as an early change that persists into the chronic phase, while in small animal models it occurs in the late phase only (95). This implies that even given the extensive experimentation on animal models, there are some limitations in the application of this knowledge to humans to be considered when planning clinical trials and experimental treatments.…”

“…On the other hand, a wide range of drugs are systemically administered to cope with RT induced chronic response. Examples of this class of pharmaceuticals are represented by WF10, also known as Tetrachlorodecaoxygen (TCDO), a formulation given intravenously able to stimulate natural immunity in order to reduce inflammation; sodium pentosan polysulphate (SPP), a synthetic sulphated polysaccharide that decrease urothelial permeability by replacing defective glycosaminoglycans; tranexamic acid, used to inhibit fibrinolysis and prevent clot urinary retention in patients with hemorragic cystitis (95).…”

“…For this reason, local treatments and bladder irrigation are considered the first line of intervention in all grades of the disease (101), aiming at protect the urothelium, arrest focal bleeding points and remove blood clots. Several agents are employed as intravesical therapies and directed at improving bladder compliance (102) including formalin, aluminum salts, hyaluronic acid, prostaglandins, botulinum toxin, polydeoxyribonucleotides and early placental extract (83,95).…”

“…In recent years, hyperbaric oxygen and laser ablation have also emerged as non-invasive management options able to produce symptom relief and stop the progression of the pathologic process. They are, however, cumbersome for patients, requiring lengthy treatments and, in case of ablation a performance status that typically patients with radiation-induced cystitis do not have (83,95,103).…”

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

“…129,130 Bleeding and fistulation can lead to formation of blood cloths, which may lead to urinary retention and anemia, requiring catheterization or urinary deviation, blood transfusion, and even cystectomy in the more severe cases. 131 The LENT/SOMA scale exists for several organ systems and is widely used. It mixes patient-perceived symptoms, management, and objective findings.…”