Hemorrhagic cystitis can have a variety of causes. The more common one is radiation injury, and radiation cystitis often occurs after radiation therapy for bladder, prostate, rectal, and cervical cancer. Hematuria can occur suddenly or can become chronic. It eventually leads to bladder fibrosis. Hematuria can be mild or very severe, and can occur months or more than 10 years after completion of radiation therapy. Its occurrence is not significantly related to age, pre-radiotherapy staging (FIGO), conventional intracavitary therapy and post-mounted intracavitary radiotherapy, but rather to the local condition of the tumor.
Other common adverse drug reactions Some anticancer drugs can directly or indirectly irritate the bladder mucosal epithelium and cause hemorrhagic cystitis. These include: intravenous chemotherapy, intravesical perfusion, bone marrow transplantation, etc.
The next is drug allergic reaction, penicillins and Danazol (a synthetic steroid) cause hemorrhagic cystitis have been reported in cases.
Treatment for hemorrhagic cystitis is divided into mild to moderate treatment and severe treatment. For mild to moderate acute radiation cystitis, conservative therapies such as antibiotics for anti-inflammation, hemostasis and symptomatic treatment are used to relieve bladder irritation. Drugs are available for systemic use in a similar way to general cystitis. Local treatment is also available: 1. Drug bladder irrigation. Bladder irrigation 2 times daily.
2, Drug bladder irrigation via catheter, retaining the drug in the bladder for several minutes and then releasing it.
3, alum liquid bladder irrigation therapy. Retain for 20 minutes to discharge. The same method can be repeatedly flushed 3 times.
4.Transurethral electrocoagulation to stop the bleeding. Due to poor blood supply to the radiation-injured tissue, fibrosis is easily formed, regeneration is low, and necrosis is likely to occur at the coagulation site, so care should be taken to prevent the formation of fistula.
5.Presacral closure therapy. Once every 5-7 days. 2-3 times after treatment, it is possible to relieve the symptoms.
6. Hyperbaric oxygen therapy.
Hyperbaric oxygen therapy for hemorrhagic radiation cystitis that cannot be treated with other methods can receive unexpected results. There are many domestic and foreign reports. It can make the oxygen tension in the tissue increase, new blood vessel and granulation tissue formation, tissue damage repair, thus promoting the healing of inflammation. In units where it is available, hyperbaric oxygen can be used as one of the means of treating radiation cystitis. Patients receive 100% oxygen in a hyperbaric chamber once a day for 60-90 minutes, 5-6 times a week for 20 sessions.
A 2001 report noted that 12 patients with radiation hemorrhagic cystitis, all of whom were treated with drugs, perfusion and electrocautery without improvement, two of whom required blood transfusion therapy, improved after hyperbaric oxygen therapy, nine of whom were cured, two of whom had only microscopic hematuria, and one of whom had visible but markedly improved carnivorous hematuria.
In another report, the authors observed that in 10 patients with hemorrhagic radiation cystitis followed for 6 years, after 1-4 courses of hyperbaric oxygen therapy, all patients had stopped bleeding and bladder irritation disappeared. The authors followed up for 1-6 years with no recurrence.
I have personally experienced many patients with hemorrhagic radiation cystitis in recent years, and I have a deep memory of a case that was transferred from a cancer hospital with bleeding for many days and several transfusions, which could only be temporarily stopped by taking various measures, and was transferred to our urology department, where hyperbaric oxygen therapy was performed immediately after taking hemostatic measures to temporarily stop the bleeding. He was discharged from the hospital after 20 hyperbaric oxygen treatments. No recurrence at 5 years follow-up.
Hyperbaric oxygen has excellent efficacy in the treatment of refractory hemorrhagic cystitis. It can rapidly improve the ischemia and hypoxia of bladder mucosa due to various causes, establish collateral circulation and promote tissue repair.