Development of a Management Algorithm for Acute and Chronic Radiation Urethritis and Cystitis

Abstract

<b><i>Objective:</i></b> The purpose of this review was to summarize the current literature on the assessment and treatment of radiation urethritis and cystitis (RUC) for the development of an evidenced-based management algorithm. <b><i>Material and Methods:</i></b> The PubMed/MEDLINE database was searched by a multidisciplinary group of experts in January 2021. <b><i>Results:</i></b> In total, 48 publications were identified. Three different types of RUC can be observed in clinical practice: inflammation-predominant, bleeding-predominant, and the combination of inflammation- and bleeding-RUC. There is no consensus on the optimal treatment of RUC. Inflammation-predominant RUC should be treated symptomatically based on the existence of bothersome storage or voiding lower urinary tract symptom as well as on pain. When bleeding-predominant RUC has occurred, hydration and hyperbaric oxygen therapy (HOT) should be used first and, if HOT is not available, oral drugs instead (sodium pentosane polysulfate, aminocaproic acid, immunokine WF 10, conjugated estrogene, or pentoxifylline + vitamin E). If local bleeding persists, focal therapy of bleeding vessels with a laser or electrocoagulation is indicated. In case of generalized bleeding, intravesical installation should be initiated (formalin, aluminium salts, and hyaluronic acid/chondroitin). Vessel embolization is a less invasive treatment with potentially less complications and good clinical outcomes. Open- or robot-assisted surgery is indicated in patients with permanent, life-threatening bleeding, or fistulae. <b><i>Conclusions:</i></b> Treatment of RUC, if not self-limiting, should be done according to the type of RUC and in a stepwise approach. Conservative/medical treatment (oral and topic agents) should primarily be used before invasive (transurethral) treatments.

Advanced Sensoring Technologies for Evaluation and Management of Lower Urinary Tract Symptoms

“…[36] According to the course of disease and symptoms, cystitis can be divided into acute cystitis and chronic cystitis, resulting in patients with lower urinary tract symptoms such as frequency, urgency, and dysuria. [37] In addition to the diseases mentioned above, there are also other infectious and inflammatory factors attributing to LUTS, such as balanitis caused by chemicals, allergies and infections, and sexually transmitted diseases (gonorrhea, syphilis, herpes, etc.). [38]…”

“…[ 36 ] According to the course of disease and symptoms, cystitis can be divided into acute cystitis and chronic cystitis, resulting in patients with lower urinary tract symptoms such as frequency, urgency, and dysuria. [ 37 ]…”

Understanding Molecular Mechanisms and Identifying Key Processes in Chronic Radiation Cystitis

“…Therefore, the pathology of CRC should include the following urinary symptoms: frequency, urgency, dysuria, hematuria, pain, degradation of quality of life [21]. Cytoscopy can be used to classify the three main forms of CRC [22]: a predominantly inflammatory form with edema, mucosal pallor and possible ulceration, a predominantly bleeding form with friability, spontaneous hemorrhage and telangiectasia, and a mixed form with features of inflammatory CRC and hemorrhagic CRC [19,[22][23][24][25].…”

“…Treatments for pain in the voiding phase are α1-adrenoceptor antagonists (α1-blockers), corticosteroids, as well as catheterization to avoid pain. General pain can be treated with paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) [22,36]. In the case of hemorrhagic CRC, the first step is to establish the origin of the bleeding.…”

“…If the CRC continues to worsen, it is possible to cauterize the blood vessels (via laser, fulguration, or electrocoagulation) and then embolize the bladder and prostate arteries. If this is not enough, it is possible to perform laparoscopy, partial bladder removal or urinary diversion and, as a last resort, a cystectomy [6,7,22,[38][39][40][41]. The effect of treatment on the parameters of pollakiuria, dysuria and pain have not been extensively studied, the result of only a partial evaluation of the effectiveness of the therapies tested.…”