Guidelines for the diagnosis, prevention and management of chemical- and radiation-induced cystitis

Abstract

Background Haemorrhagic cystitis (HC) is most commonly caused by intravenous chemotherapy drugs, notably cyclophosphamide, 1,2 administration of treatments directly into the bladder (e.g. bacillus Calmette-Guérin), 3,4 or radiation therapy to the pelvic area. 5 Cases of HC have also been reported with the use of other therapeutic agents, 2,6-9 recreational drugs 10 and environmental toxins. 11 HC has a spectrum of manifestations that range from non-visible (or microscopic) haematuria to gross (visible) haematuria with clots, 12 and has a reported incidence from less than 10% up to 35%. 4,5,13-15 Severe HC can be a challenging condition to treat and may give rise to serious complications, 16 leading to prolonged hospitalisation and occasional mortality. 12 Several reviews of the available preventive and therapeutic options for chemical-and radiation-induced cystitis

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

“…Initial management involves stabilization with fluid resuscitation, insertion of a large 24–26‐F three‐way indwelling catheter, manual washout with extensive clot evacuation and commencement of continuous bladder irrigation. Tranexamic acid, administered orally, intravenously or intravesically, may be considered in the initial conservative management of urological haemorrhage .…”

Translational Aspects of Nuclear Factor-Kappa B and Its Modulation by Thalidomide on Early and Late Radiation Sequelae in Urinary Bladder Dysfunction

“…Alum and formalin target severe hematuria, whereas the instillation of glycosaminoglycans aims to protect the urothelium from mechanical and chemical stress. 2,3,30 Systemic therapy approaches, such as the administration of TCDO/WF10, take advantage of immunomodulatory properties. 31,32 Most systemic and local treatments that showed therapeutic modifications did not affect the development of chronic radiation fibrosis.…”

Evaluation of Hyperbaric Oxygen Therapy in the Treatment of Radiation-induced Hemorrhagic Cystitis

“…HBO therapy is used to treat PRH and many other diseases as an adjuvant therapy (2)(3)(4). The efficacy has been found lower than previous studies.…”

“…The authors stated that the median number of HBO sessions was 29 (ranging from 3 to 50 sessions). The patients should have at least 20 HBO sessions because fewer than 20 sessions do not show enough benefit (4). Furthermore, we do not know how many patients who have fewer than 20 sessions were included in this study.…”

“…But, they did not eliminate the infections. Documentation of noninfectious HC requires a negative urine culture for bacteria (4). In all patients, should obtain a urinary culture in order to diagnose a urinary tract infection and to identify the bacteria causing the infection so it can be treated.…”