1. Department of Urology, Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
2. Department of Invasive Technology, Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
3. Department of Urology, Hubei Provincial Cancer Hospital, Wuhan, China.
4. Department of Urology, Hunan Provincial Cancer Hospital, Changsha, China.
5. Department of Urology, Jiangxi Provincial Cancer Hospital, Nanchang, China.
6. Department of Urology, Zhejiang Provincial Cancer Hospital, Hangzhou, China.
7. Department of Urology, Jiangsu Provincial Cancer Hospital, Nanjing, China.
Background: Curing hemorrhagic cystitis remains a challenge. We explore a continuous and effective treatment for hemorrhagic radiation cystitis.
Methods: The data of patients in 6 provincial cancer hospital urology departments between April 2015 and December 2019 was reviewed retrospectively. Patients were classified as moderate and severe groups. The 5-steps sequential method was adopted. Two groups were initiated with step 1 and step 3 respectively. Step 1 was symptomatic treatment. Thrombin solution or sodium hyaluronate was administrated for bladder irrigation in step 2. Step 3 was transurethral electrocoagulation. Step 4 was interventional embolization. Step 5 was HBO therapy. OABSS was used to assess the improvement of patients' symptoms. The outcome was evaluated after at least 6 months of follow-up.
Results: A total of 650 patients (56 men and 594 women), mean age 71.2 years, were enrolled in the 5 steps sequential method. 582 patients were classified as moderate and 68 severe group. In moderate group, the cure rate of step 1 was 61.2% (356/582), 80.4% (468/582) after step 2, 93.1% (542/582) after step 3, 96.2% (560/582) after step 4, and 99.8% (581/582) after step 5. In severe group, the cure rate was 54.4% (37/68) after step 3, 76.5% (52/68) after step 4, and 94.1% (64/68) after the step 5 respectively. The mean OABSS scores of both groups significantly decreased after 5 steps sequential method treatment (P<0.01).
Conclusions: Our results show hemorrhagic radiation cystitis can be cured in 5 steps, and the 5 steps sequential method is welcomed and effective. Therapy efficacy depends on the number of steps adopted and the severity of hematuria.
Keywords: Hemorrhagic cystitis, Sodium hyaluronate, transurethral electrocoagulation, transcatheter arterial embolization, hyperbaric oxygen