Radiation-induced cystitis

Pelvic radiotherapy causes chronic fibrosis and progressive endarteritis in poorly oxygenated bladder submucosal and muscular tissues, with eventual tissue scarring. This can potentially lead to bladder mucosal sloughing and symptomatic hemorrhagic cystitis. Delayed radiation-induced hemorrhagic cystitis can occur six months to ten years after pelvic irradiation. Numerous studies have reported the incidence of moderate to severe hematuria in a range of 3% to 5% after radiotherapy. The primary treatment modality for hemorrhagic cystitis is bladder irrigation. Oral and intravenous agents such as aminocaproic acid, estrogens, and sodium pentosan polysulfate have been tried with limited success. Intravesical treatments with alum silver nitrate, prostaglandins, or formalin are sometimes used when bleeding persists. Finally, selective embolization of the hypogastric arteries, urinary diversion, and cystectomy may be performed as necessary in the most severe cases. Recently, hyperbaric oxygen has emerged as a potential primary option for the management of this challenging condition.