Der Urologe

, Volume 56, Issue 3, pp 301–305 | Cite as

Radiogen bedingte Zystitis

Pathophysiologie und Therapie
  • S. Mühlstädt
  • N. Mohammed
  • K. Weigand
  • A. Schumann
  • F. Kawan
  • C. Göllert
  • P. Fornara
Leitthema
  • 207 Downloads

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.

Schlüsselwörter

Bestrahlung Strahlenzystitis Hämaturie Harnblase Koagulation, transurethrale 

Radiation cystitis

Pathophysiology and treatment

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.

Keywords

Radiation Radiation cystitis Hematuria Urinary bladder Coagulation, transurethral 

Notes

Einhaltung ethischer Richtlinien

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.

Literatur

  1. 1.
    Abern MR, Dude AM, Tsivian M, Coogan CL (2013) The characteristics of bladder cancer after radiotherapy for prostate cancer. Urol Oncol 31(8):1628–1634CrossRefPubMedGoogle Scholar
  2. 2.
    (2011) AUA-Guideline on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain SyndromeGoogle Scholar
  3. 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 4:281–286PubMedPubMedCentralGoogle Scholar
  4. 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 CrossRefGoogle Scholar
  5. 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):322–328CrossRefGoogle Scholar
  6. 6.
    Chong V, Rice M (2016) The effectiveness of hyperbaric oxygen therapy (HBOT) in radiation-induced haemorrhagic cystitis. N Z Med J 129(1446):79–83PubMedGoogle Scholar
  7. 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):704–706CrossRefPubMedGoogle Scholar
  8. 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):31–38CrossRefGoogle Scholar
  9. 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):1679–1681CrossRefPubMedGoogle Scholar
  10. 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):296–305CrossRefPubMedGoogle Scholar
  11. 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. 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):131–135CrossRefPubMedGoogle Scholar
  13. 13.
    (2016) EUA-Guideline Prostate CancerGoogle Scholar
  14. 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):95–102CrossRefPubMedGoogle Scholar
  15. 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):725–730CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hermans TJ, Delaere KP, Mens JW, Paffen ML (2012) Necrotic bladder following radiotherapy for cervical carcinoma. Ned Tijdschr Geneeskd 155(35):A4951PubMedGoogle Scholar
  17. 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):2232–2250CrossRefGoogle Scholar
  18. 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):125–126CrossRefPubMedGoogle Scholar
  19. 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):232–235CrossRefPubMedGoogle Scholar
  20. 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):1257–1280CrossRefPubMedGoogle Scholar
  21. 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):270CrossRefGoogle Scholar
  22. 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):584–587CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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):71–74CrossRefPubMedGoogle Scholar
  24. 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):208–214CrossRefPubMedGoogle Scholar
  25. 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):12–19CrossRefPubMedGoogle Scholar
  26. 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):733–740CrossRefPubMedGoogle Scholar
  27. 27.
    Pavlidakey PG, MacLennan GT (2009) Radiation cystitis. J Urol 182(3):1172–1173CrossRefPubMedGoogle Scholar
  28. 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):578–584CrossRefPubMedGoogle Scholar
  29. 29.
    Shah SK, Lui PD, Baldwin DD, Ruckle HC (2006) Urothelial carcinoma after external beam radiation therapy for prostate cancer. J Urol 175(6):2063–2066CrossRefPubMedGoogle Scholar
  30. 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):691–694CrossRefPubMedGoogle Scholar
  31. 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):2008–2010PubMedPubMedCentralGoogle Scholar
  32. 32.
    Smit SG, Heyns CF (2010) Management of radiation cystitis. Nat Rev Urol 7(4):206–214CrossRefPubMedGoogle Scholar
  33. 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):545–548PubMedGoogle Scholar
  34. 34.
    Wang PH, Horng HC, Lee WL (2011) Treatment of acute radiation cystitis: comment. Int Urogynecol J 22(9):1203–1204CrossRefPubMedGoogle Scholar
  35. 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):78–81CrossRefPubMedGoogle Scholar
  36. 36.
    Zwaans BM, Chancellor MB, Lamb LE (2016) Modeling and Treatment of Radiation Cystitis. Urology 88:14–21CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag Berlin 2017

Authors and Affiliations

  • S. Mühlstädt
    • 1
  • N. Mohammed
    • 1
  • K. Weigand
    • 1
  • A. Schumann
    • 1
  • F. Kawan
    • 1
  • C. Göllert
    • 1
  • P. Fornara
    • 1
  1. 1.Universitätsklinik für Urologie und NierentransplantationMartin-Luther-UniversitätHalle/SaaleDeutschland

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