Clinical management of radiation cystitis: a narrative review

Abstract

Radiation therapy for various pelvic cancers has led to secondary complications becoming increasingly commonplace. Radiation cystitis is an undesired side effect with a wide spectrum of severity ranging from mild irritative voiding symptoms to life threatening hemorrhagic cystitis (HC). As such, the management of radiation cystitis too has a wide range of potential treatment options. Hyperbaric oxygen therapy can be utilized in the outpatient setting in the stable patient. For the more symptomatic patient, emptying the bladder of any clots followed by continuous bladder irrigation is first line treatment. If the bleeding persists after this, systemic therapies such as systemic tranexamic acid (TXA) or sodium pentosan polysulfate (Elmiron) are options however these have mixed outcomes in the literature. Intravesical treatments of aminocaproic acid (Amicar), aluminum or formalin can be trialed to abate bleeding, however each come with their own side effect profiles. In the case of refractory bleeding to these conservative measures, or in the unstable patient, vascular embolization can be utilized. Urinary diversion with or without cystectomy is a definitive treatment however these surgeries are generally more complicated due to the radiation history. Herein, we review in detail the relevant literature of available medical and surgical techniques for treatment as well as offer our own experience in managing this challenging disease process.