Radiation Cystitis

Abstract

The bladder is incidentally exposed during radiation therapy for cancer involving pelvic structures. Radiation exposure induces urothelium damage and perivascular fibrosis, as well as traumatizes the detrusor smooth muscle, resulting in a decrease in bladder compliance and capacity. The acute and subacute phases of radiation cystitis (RC) occur during or within 3–6 months after therapy. On the other hand, late RC can develop from 6 months to years after radiation treatment. Clinical symptoms may include storage and voiding symptoms, pelvic pain and hematuria. The diagnosis is focused on the exclusion of other causes. The oral therapies include analgesics, anticholinergics, alpha-blockers and 5-reductase inhibitors. Intravesical instillation (e.g., prostaglandin, formalin, hyaluronic acid) have been used for the treatment of late RC. The management of hemorrhagic cystitis is tailored according to the severity of the symptoms, involving conservative measures, hyperbaric oxygen, fulguration, selective embolization, urinary diversion or cystectomy.