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

B.G.L. Vanneste*, E.J. Van Limbergen, T.A. Marcelissen, J.G.H. van Roermund, L.C. Lutgens, C.W.K.P. Arnoldussen, P. Lambin, M. Oelke

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

2 Citations (Web of Science)

Abstract

Objective: 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. Material and Methods: The PubMed/MEDLINE database was searched by a multidisciplinary group of experts in January 2021. Results: 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. Conclusions: 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.
Original languageEnglish
Pages (from-to)63-74
Number of pages12
JournalUrologia Internationalis
Volume106
Issue number1
Early online date15 Jun 2021
DOIs
Publication statusPublished - Jan 2022

Keywords

  • Radiotherapy
  • Radiation urethritis
  • Radiation cystitis
  • Prevention
  • Treatment
  • HYPERBARIC-OXYGEN THERAPY
  • INDUCED HEMORRHAGIC CYSTITIS
  • TRANSURETHRAL RESECTION
  • PROSTATE
  • BRACHYTHERAPY
  • RADIOTHERAPY
  • TOXICITY
  • SAFETY
  • PENTOXIFYLLINE
  • INSTILLATION

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