Treatment of Severe Refractory Hematuria due to Radiation-Induced Hemorrhagic Cystitis with Dexamethasone

Abstract

Treatment of pelvic neoplasms with radiotherapy may develop sequelae, especially RHC. An 85-year-old male patient was admitted to a hospital emergency with gross hematuria leading to urinary retention and was diagnosed with RHC. The urinary bladder was probed, unobstructed, and maintained in continuous three-way saline irrigation. During 45 days of hospitalization, the patient underwent two cystoscopic procedures for urinary bladder flocculation, whole blood transfusions, and one platelet apheresis. None of these interventions led to clinical resolution. As the patient hematological condition was deteriorating, dexamethasone (4 mg i.v., bolus of 6/6, 12/12, and 24 h during five days) and epoetin alpha (1000 IU, 1 ml, s.c., for four weeks) were administered which led to the remission of the urinary bleeding. Dexamethasone therapy may be considered for RHC, when conventional treatments are not effective or are not possible, avoiding more aggressive interventions such as cystectomy.

Development of radiation countermeasure agents for acute radiation syndromes

“…49 For example, palifermin, a recombinant keratinocyte growth factor (truncated N-terminal), can prevent or reverse IR-induced mucositis, 50 and radioprotective effects have been demonstrated for several bioengineered erythropoietin analogs, such as darbepoetin alfa, epoetin alfa, Epogen, interleukin-3, interleukin-11, and thrombopoietin. [51][52][53][54][55][56][57] Medical advancements that have led to reductions in adverse effects after radiotherapy as well as radiation-induced bystander effects have also aided in the development of mitigation strategies, for example, the activation of tissue repair mechanisms via growth factors and cytokines; prevention of side effects by prebiotics and probiotics; and a reduction in inflammation by bevacizumab, cyclooxygenase inhibitors, angiotensin-converting enzyme inhibitors, and statins. [58][59][60][61][62] Many drugs with antioxidant and anti-inflammatory effects can prevent DNA damage and reduce the risk of tumor development.…”

“…In addition to the aforementioned cytokines, some other cytokines have shown to exert protective effects against IR injury 49 . For example, palifermin, a recombinant keratinocyte growth factor (truncated N‐terminal), can prevent or reverse IR‐induced mucositis, 50 and radioprotective effects have been demonstrated for several bioengineered erythropoietin analogs, such as darbepoetin alfa, epoetin alfa, Epogen, interleukin‐3, interleukin‐11, and thrombopoietin 51–57 …”

Molecular Mechanisms and Key Processes in Interstitial, Hemorrhagic and Radiation Cystitis

“…These treatments have a low level of efficacy (<50%) and their effects stop when treatment is stopped [ 88 , 91 , 92 ]. As for corticoids, their action remains limited in time [ 93 , 94 ]. In order to reduce hemorrhages, intravesical instillation of formalin or alum can be used.…”

Urological complications after radiation therapy—nothing ventured, nothing gained: a Narrative Review

“…Due to insufficient data, other methods cannot be recommended as routine management of chronic radiation cystitis. These include the use of placental extract ( 79 ), prostaglandins ( 80 - 82 ), silver nitrate ( 83 - 86 ), epsilon aminocaproic acid ( 87 ), hyaluronic acid ( 88 ), recombinant factor VII ( 89 , 90 ), dexamethasone ( 91 ), tacrolimus ( 92 , 93 ).…”