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Radiogen bedingte Zystitis

Pathophysiologie und Therapie

Radiation cystitis

Pathophysiology and treatment

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Zusammenfassung

Die Strahlenzystitis (SZ) ist eine häufige Nebenwirkung einer Radiatio im Bereich des kleinen Beckens. Ihr klinisches Erscheinungsbild sowie ihr Ausprägungsgrad ebenso wie die therapeutischen Optionen sind mannigfaltig. Mangels randomisierter Untersuchungen sind evidente Empfehlungen jedoch schwierig. Unterschieden werden orale systemische Therapien, intravesikale Instillationen und Interventionen sowie interventionsradiologische und, als Ultima Ratio, chirurgische Maßnahmen. Der vorliegende Artikel gibt eine Übersicht über die unterschiedlichen Therapieoptionen mit besonderem Schwerpunkt auf den konservativ-interventionellen Behandlungsoptionen.

Abstract

Radiation cystitis (RC) is a common side-effect of radiation to the pelvis. Their clinical appearance as well as their degree of expression is manifold, as are the therapeutic options. However, in the absence of randomized examinations, recommendations are difficult. We differentiate between oral, systemic therapies, intravesical instillations and interventions as well as interventional, radiological and, as an ultima ratio, surgical treatments. This article provides an overview of the different treatment options with particular emphasis on the conservative-interventional therapy options.

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Literatur

  1. Abern MR, Dude AM, Tsivian M, Coogan CL (2013) The characteristics of bladder cancer after radiotherapy for prostate cancer. Urol Oncol 31(8):1628–1634

    Article  PubMed  Google Scholar 

  2. (2011) AUA-Guideline on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome

  3. Bonetta A, Di Pierro F (2012) Enteric-coated, highly standardized cranberry extract reduces risk of UTIs and urinary symptoms during radiotherapy for prostate carcinoma. Cancer Manag Res 4:281–286

    PubMed  PubMed Central  Google Scholar 

  4. Browne C, Davis NF, Mac Craith E, Lennon GM, Mulvin DW, Quinlan DM, Mc Vey GP, Galvin DJ (2015) A narrative review on the pathophysiology and management for radiation cystitis. Adv Urol 2015:1. doi:10.1155/2015/346812

    Article  Google Scholar 

  5. Campbell G, Pickles T, D’yachkova Y (2003) A randomised trial of cranberry versus apple juice in the management of urinary symptoms during external beam radiation therapy for prostate cancer. Clin Oncol 15(6):322–328

    Article  CAS  Google Scholar 

  6. Chong V, Rice M (2016) The effectiveness of hyperbaric oxygen therapy (HBOT) in radiation-induced haemorrhagic cystitis. N Z Med J 129(1446):79–83

    PubMed  Google Scholar 

  7. Chuang YC, Kim DK, Chiang PH, Chancellor MB (2008) Bladder botulinum toxin A injection can benefit patients with radiation and chemical cystitis. BJU Int 102(6):704–706

    Article  CAS  PubMed  Google Scholar 

  8. Cowan CC, Hutchison C, Cole T, Barry SJ, Paul J, Reed NS, Russell JM (2012) A randomised double-blind placebo-controlled trial to determine the effect of cranberry juice on decreasing the incidence of urinary symptoms and urinary tract infections in patients undergoing radiotherapy for cancer of the bladder or cervix. Clin Oncol 24(2):31–38

    Article  Google Scholar 

  9. Dave CN, Chaus F, Chancellor MB, Lajness M, Peters KM (2015) Innovative use of intravesical tacrolimus for hemorrhagic radiation cystitis. Int Urol Nephrol 47(10):1679–1681

    Article  CAS  PubMed  Google Scholar 

  10. Dellis A, Deliveliotis C, Kalentzos V, Vavasis P, Skolarikos A (2014) Is there a role for hyberbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? A prospective pilot-feasibility study and review of literature. Int Braz J Urol 40(3):296–305

    Article  PubMed  Google Scholar 

  11. Denton AS, Clarke NW, Maher EJ (2002) Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev. doi:10.1002/14651858.cd001773

    Google Scholar 

  12. Dewan AK, Mohan GM, Ravi R (1993) Intravesical formalin for hemorrhagic cystitis following irradiation of cancer of the cervix. Int J Gynaecol Obstet 42(2):131–135

    Article  CAS  PubMed  Google Scholar 

  13. (2016) EUA-Guideline Prostate Cancer

  14. Hamilton K, Bennett NC, Purdie G, Herst PM (2015) Standardized cranberry capsules for radiation cystitis in prostate cancer patients in New Zealand: a randomized double blinded, placebo controlled pilot study. Support Care Cancer 23(1):95–102

    Article  PubMed  Google Scholar 

  15. Hazewinkel MH, Stalpers LJ, Dijkgraaf MG, Roovers JP (2011) Prophylactic vesical instillations with 0.2 % chondroitin sulfate may reduce symptoms of acute radiation cystitis in patients undergoing radiotherapy for gynecological malignancies. Int Urogynecol J 22(6):725–730

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hermans TJ, Delaere KP, Mens JW, Paffen ML (2012) Necrotic bladder following radiotherapy for cervical carcinoma. Ned Tijdschr Geneeskd 155(35):A4951

    PubMed  Google Scholar 

  17. Jhang JF, Kuo HC (2015) Novel treatment of chronic bladder pain syndrome and other pelvic pain disorders by onabotulinumtoxin A injection. Toxins (Basel) 7(6):2232–2250

    Article  CAS  Google Scholar 

  18. Likourinas M, Cranides A, Jiannopoulos B, Kostakopoulos A, Dimopoulos C (1979) Intravesical formalin for the control of intractable bladder haemorrhage secondary to radiation cystitis or bladder cancer. Urol Res 7(2):125–126

    Article  CAS  PubMed  Google Scholar 

  19. Lojanapiwat B, Sripralakrit S, Soonthornphan S, Wudhikarn S (2002) Intravesicle formalin instillation with a modified technique for controlling haemorrhage secondary to radiation cystitis. Asian J Surg 25(3):232–235

    Article  CAS  PubMed  Google Scholar 

  20. Marks LB, Carroll PR, Dugan TC, Anscher MS (1995) The response of the urinary bladder, urethra, and ureter to radiation and chemotherapy. Int J Radiat Oncol Biol Phys 31(5):1257–1280

    Article  CAS  PubMed  Google Scholar 

  21. Martin Liberal J, Maroto JP, Mellado B, Ferrer F, Sancho G, Rovirosa A, Vigues F, Palou J, Ribal MJ, Bellmunt J, Garcia Del Muro X (2012) Phase I trial of sorafenib with concurrent radiotherapy (RT) in patients with invasive bladder cancer treated with bladder-sparing intent: a Spanish Oncology Genitourinary Group study. J Clin Oncol 30(5suppl):270

    Article  Google Scholar 

  22. Martinez DR, Ercole CE, Lopez JG, Parker J, Hall MK (2015) A novel approach for the treatment of radiation-induced hemorrhagic cystitis with the greenlightTM XPS laser. Int Braz J Urol 41(3):584–587

    Article  PubMed  PubMed Central  Google Scholar 

  23. Milani R, Scalambrino S, Carrera S, Pezzoli P, Ruffmann R (1988) Flavoxate hydrochloride for urinary urgency after pelvic radiotherapy: comparison of 600 mg versus 1200 mg daily dosages. J Int Med Res 16(1):71–74

    Article  CAS  PubMed  Google Scholar 

  24. Nakada T, Nakada H, Yoshida Y, Nakashima Y, Banya Y, Fujihira T, Karasawa K (2012) Hyperbaric oxygen therapy for radiation cystitis in patients with prostate cancer: a long-term follow-up study. Urol Int 89(2):208–214

    Article  CAS  PubMed  Google Scholar 

  25. Niezgoda JA, Serena TE, Carter MJ (2016) Outcomes of radiation injuries using hyperbaric oxygen therapy: an observational cohort study. Adv Skin Wound Care 29(1):12–19

    Article  PubMed  Google Scholar 

  26. Oliai C, Fisher B, Jani A, Wong M, Poli J, Brady LW, Komarnicky LT (2012) Hyperbaric oxygen therapy for radiation-induced cystitis and proctitis. Int J Radiat Oncol Biol Phys 84(3):733–740

    Article  CAS  PubMed  Google Scholar 

  27. Pavlidakey PG, MacLennan GT (2009) Radiation cystitis. J Urol 182(3):1172–1173

    Article  PubMed  Google Scholar 

  28. Rajaganapathy BR, Janicki JJ, Levanovich P, Tyagi P, Hafron J, Chancellor MB, Krueger S, Marples B (2015) Intravesical liposomal tacrolimus protects against radiation cystitis induced by 3‑beam targeted bladder radiation. J Urol 194(2):578–584

    Article  CAS  PubMed  Google Scholar 

  29. Shah SK, Lui PD, Baldwin DD, Ruckle HC (2006) Urothelial carcinoma after external beam radiation therapy for prostate cancer. J Urol 175(6):2063–2066

    Article  PubMed  Google Scholar 

  30. Shao Y, Lu GL, Shen ZJ (2012) Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int 109(5):691–694

    Article  PubMed  Google Scholar 

  31. Shi F, Wang T, Wang J, Hui B, Chai Y, Wang J, Liu Z (2016) Peritoneal bladder fistula following radiotherapy for cervical cancer: a case report. Oncol Lett 12(3):2008–2010

    PubMed  PubMed Central  Google Scholar 

  32. Smit SG, Heyns CF (2010) Management of radiation cystitis. Nat Rev Urol 7(4):206–214

    Article  PubMed  Google Scholar 

  33. Wakamiya T, Kuramoto T, Inagaki T (2016) Two cases of spontaneous rupture of the urinary bladder associated with radiation cystitis, repaired with omentum covering. Hinyokika Kiyo 62(10):545–548

    PubMed  Google Scholar 

  34. Wang PH, Horng HC, Lee WL (2011) Treatment of acute radiation cystitis: comment. Int Urogynecol J 22(9):1203–1204

    Article  PubMed  Google Scholar 

  35. Zhu J, Xue B, Shan Y, Yang D, Zang Y (2013) Transurethral coagulation for radiation-induced hemorrhagic cystitis using Greenlight™ potassium-titanyl-phosphate laser. Photomed Laser Surg 31(2):78–81

    Article  PubMed  Google Scholar 

  36. Zwaans BM, Chancellor MB, Lamb LE (2016) Modeling and Treatment of Radiation Cystitis. Urology 88:14–21

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland

    S. Mühlstädt FEBU, N. Mohammed, K. Weigand, A. Schumann, F. Kawan, C. Göllert & P. Fornara

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  1. S. Mühlstädt FEBU
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  2. N. Mohammed
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  3. K. Weigand
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  4. A. Schumann
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  5. F. Kawan
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  6. C. Göllert
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  7. P. Fornara
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Correspondence to S. Mühlstädt FEBU.

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Interessenkonflikt

S. Mühlstädt, N. Mohammed, K. Weigand, A. Schumann, F. Kawan, C. Göllert und P. Fornara geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Mühlstädt, S., Mohammed, N., Weigand, K. et al. Radiogen bedingte Zystitis. Urologe 56, 301–305 (2017). https://doi.org/10.1007/s00120-017-0319-2

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  • DOI: https://doi.org/10.1007/s00120-017-0319-2

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