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Minerva Urology and Nephrology 2021 Oct 29

DOI: 10.23736/S2724-6051.21.04539-0


language: English

Current management of radiation cystitis after pelvic radiotherapy: a systematic review

Michele MARCHIONI 1 , Piergustavo DE FRANCESCO 1, Riccardo CAMPI 2, Umberto CARBONARA 3, Matteo FERRO 4, Luigi SCHIPS 1, Juan GOMEZ RIVAS 5, Rocco PAPALIA 6, Roberto M. SCARPA 6, Francesco ESPERTO 6

1 Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy; 2 Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy; 3 Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy; 4 Department of Urology, IRCSS European Institute of Oncology (IEO), Milan, Italy; 5 Department of Urology, La Paz University Hospital, Madrid, Spain; 6 Department of Urology, Campus Bio-Medico University, Rome, Italy


INTRODUCTION: We aimed to summarize current literature about radiation cystitis treatments, providing physician of a summary of current management options.
EVIDENCE ACQUISITION: A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in March 2021. PRISMA guidelines were followed. Population consisted of patients with a diagnosis of radiation cystitis after pelvic radiotherapy (P). We focused our attention on different treatments, such as conservative or surgical one (I). Single or multiple arms studies were deemed eligible with no mandatory comparison (C). Main outcomes of interest were symptoms control and adverse events rates (O).
EVIDENCE SYNTHESIS: The search identified 1,194 records. Of all, four studies focused on the use of hyperbaric oxygen therapy showing complete response rates ranging from 52 to 87% approximately. Oral administration of cranberry compounds was investigated in one study showing no superiority to placebo. Intravesical instillation of different compounds were investigated in five studies showing the highest complete response rates after alum (60%) and formalin administration (75%). Endoscopic conservative surgical treatments (fibrin glue or vaporization) also showed 75% complete response rates. In patients who did not respond to conservative treatments robotic cystectomy is feasible with overall complication rates of about 59.3% at 90 days.
CONCLUSIONS: Radiotherapy induced cystitis is an under-reported condition after pelvic radiotherapy. Several treatments have been proposed, but in up to 10% of cases salvage cystectomy is necessary. A stepwise approach, with progressive treatment aggressiveness is recommended.

KEY WORDS: Radiotherapy; Actinic cystitis; Prostate cancer; Bladder cancer

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