Chemical- and radiation-induced haemorrhagic cystitis: Current treatments and challenges

University College Hospital, London, UK.
BJU International (Impact Factor: 3.53). 06/2013; 112(7). DOI: 10.1111/bju.12291
Source: PubMed


Haemorrhagic cystitis (HC) can be either acute or chronic, and be caused by chemotherapeutic drugs, radiation therapy, or exposure to chemicals, such as dyes or insecticides [1]. In transplantation settings, HC is typically associated with haematopoietic stem cell transplant (HSCT), but can also occur, albeit rarely, in solid organ recipients [2]. It is thought that a defect in the glycosaminoglycan (GAG) layer, which coats the uroepithelium and provides the initial barrier for physiologic protection, may be the first step in its development [3]. Once injured or defective, the GAG layer loses its barrier properties, becomes permeable, and allows the inflammatory and hypersensitisation cycle to thrive [3].

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    • "Dysuria, frequent voiding, and urgency may be controlled with medications, but massive haematuria is a life-threatening symptom and should be immediately controlled. Hyperhydration, bladder irrigation, and agents that can detoxify cyclophosphamide such as Mesna (2-mercaptoethane sodium sulphonate) have been the most frequently used prophylactic measures to prevent treatment-related cystitis but are not always effective [72]. In the search for new prevention and treatment approaches hyperbaric oxygen therapy, flavonoids or polyphenols, and melatonin are suggested as supportive treatment, but further studies are required for their translation into clinic [59, 73, 74]. "
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    ABSTRACT: Cystitis is a urinary bladder disease with many causes and symptoms. The severity of cystitis ranges from mild lower abdominal discomfort to life-threatening haemorrhagic cystitis. The course of disease is often chronic or recurrent. Although cystitis represents huge economical and medical burden throughout the world and in many cases treatments are ineffective, the mechanisms of its origin and development as well as measures for effective treatment are still poorly understood. However, many studies have demonstrated that urothelial dysfunction plays a crucial role. In the present review we first discuss fundamental issues of urothelial cell biology, which is the core for comprehension of cystitis. Then we focus on many forms of cystitis, its current treatments, and advances in its research. Additionally we review haemorrhagic cystitis with one of the leading causative agents being chemotherapeutic drug cyclophosphamide and summarise its management strategies. At the end we describe an excellent and widely used animal model of cyclophosphamide induced cystitis, which gives researches the opportunity to get a better insight into the mechanisms involved and possibility to develop new therapy approaches.
    BioMed Research International 04/2014; 2014(2):473536. DOI:10.1155/2014/473536 · 2.71 Impact Factor
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    ABSTRACT: An 86-year-old male who presented with the chief complaint of clot retention and had a history of prostate cancer treated with external beam radiation therapy 11 years previously is described. Cystoscopy revealed radiation cystitis in coexistence with bladder cancer. Since bladder cancer may be present in patients with macroscopic hematuria who have a history of radiation therapy, referral to an urologist is recommended.
    03/2014; 4(1):53-9. DOI:10.1159/000361013
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    ABSTRACT: Introduction: This study aimed evaluate the safety and feasibility of endoscopic potassium titanyl phosphate (KTP) laser application in the management of patients with radiation-induced hemorrhagic cystitis (RHC). Technical considerations: We retrospectively reviewed the records of 20 patients with RHC who underwent endoscopic KTP laser ablation of telangiectatic bladder vessels between October 2005 and January 2013. After initial cystoscopy, KTP laser was used to ablate the submucosal vasculature while preserving the overlying mucosa. The surgical outcome was evaluated by duration of hematuria-free interval, number of episodes of hematuria, and number of required medical and/or surgical interventions after initial treatment. Overall, 20 patients underwent 26 sessions of KTP laser ablation of bladder vessels. The procedure was able to stop bleeding 92% of the time and the average hematuria-free interval after ablation was 11.8 months, with a range of 1-37 months. In 13 patients (65%) hematuria resolved after 1 session of KTP laser treatment, whereas 5 patients (25%) required multiple sessions. Two patients (10%) with severe hematuria continued to have bleeding after laser treatment, which necessitated proximal diversion of urine with percutaneous nephrostomy tubes to control bleeding. Conclusion: This study suggests that KTP laser, with its unique photoselectivity property, is a safe, effective, and durable treatment with minimal side effects for ablation of submucosal bladder vessels in patients with RHC.
    Urology 06/2014; 84(2). DOI:10.1016/j.urology.2014.03.029 · 2.19 Impact Factor
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