Radiation Cystitis
Radiation cystitis is inflammation and damage to the bladder caused by radiation therapy, usually as treatment for pelvic cancers such as prostate, cervical, bladder, or rectal cancer.
🔍 Pathophysiology
- Radiation causes damage to bladder mucosa, blood vessels, and connective tissue.
- Leads to ischemia, fibrosis, and chronic inflammation.
- Can result in hemorrhagic cystitis (bleeding from the bladder lining).
⚠️ Types
| Type | Timing | Features |
|---|---|---|
| Acute radiation cystitis | During or shortly after radiation (weeks) | Irritative urinary symptoms (frequency, urgency, dysuria), usually self-limited |
| Chronic radiation cystitis | Months to years after radiation | Persistent symptoms, hematuria, fibrosis, reduced bladder capacity |
🩺 Symptoms
- Urinary frequency and urgency
- Dysuria (painful urination)
- Hematuria (gross or microscopic)
- Pelvic pain or discomfort
- Possible urinary incontinence
🧪 Diagnosis
- History of pelvic radiation
- Urinalysis (to exclude infection)
- Cystoscopy:
- Shows mucosal telangiectasia, friability, hemorrhages, ulceration, fibrosis
- Imaging (ultrasound, CT) if needed to evaluate upper tract or rule out tumors
🛠️ Management
1. Conservative Treatment
- Hydration
- Urinary analgesics (phenazopyridine)
- Anticholinergic drugs for irritative symptoms
- Treat concurrent infections if present
2. Medical Interventions
- Bladder instillations with agents like hyaluronic acid, chondroitin sulfate, or alum
- Hyperbaric oxygen therapy to promote healing and angiogenesis
3. Surgical Treatment
- For severe cases with bleeding refractory to medical therapy:
- Cauterization of bleeding sites (cystoscopic fulguration)
- Urinary diversion or cystectomy in extreme cases
📈 Prognosis
- Acute radiation cystitis often resolves after treatment ends
- Chronic radiation cystitis can be persistent and difficult to treat
- Early intervention improves outcomes