Hemorrhagic radiation cystitis, is one of the common complications after radiotherapy for pelvic tumors. It usually occurs 6 months to ~10 years after radiotherapy, and its pathological changes are mainly bladder wall fibrosis of different degrees, bladder mucosa ulceration and bleeding, submucosal vascular dilatation and congestion, and microaneurysm formation.
The clinical manifestation is recurrent bladder bleeding of different degrees, which can be acute, subacute, or chronic in onset.
Hyperbaric oxygen can increase the partial pressure of oxygen in blood and tissues, promote aerobic metabolism, promote the vitality and division of vascular fibroblasts and the formation of collagen fibers, and accelerate capillary neovascularization. The increased partial pressure of oxygen and the oxygen supply in the new capillaries improve the hypoxic state of the radiologically damaged tissues, increase aerobic metabolism, reduce tissue edema, proliferate fibroblasts and enhance leukocyte activity, further promote granulation tissue generation at the injury site, bladder mucosa repair and accelerate ulcer healing, thus achieving the purpose of hemostasis.
Hyperbaric chamber treatment has a total efficiency of 74% and has been the main treatment for hemorrhagic cystitis. Contraindications include emphysema, pneumothorax, tympanic membrane perforation or previous tympanic membrane reconstruction, diabetes mellitus, active viral infections, during cisplatin and adriamycin therapy, and active tumor patients.
The main drugs commonly used for intravesical instillation are silver nitrate solution and formaldehyde solution. Direct necrotic coagulation of bleeding vessels to achieve hemostasis, but these drugs have severe urinary tract irritation symptoms, which are often difficult for patients to tolerate.
Hyaluronic acid is an inherent component of the human body, to the cells and cellular organs themselves, play a lubricating and nourishing role, while providing microcirculation of cellular metabolism. It is non-toxic, non-irritating and safe for the body. The disadvantage is that currently imported sodium hyaluronate (cysteine) is expensive.
Transurethral intravesical electrocoagulation stops bleeding with definite results in controlling bleeding. However, it can bleed again after the scar is removed. Interventional embolization of the internal iliac arteries bilaterally is effective for hematuria in the short term and can bleed again after a long time due to the formation of collateral circulation.