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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Available from: Robert A Huddart, Mar 31, 2015
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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: 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.
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