Incidence and Morbidity of Radiation-Induced Hemorrhagic Cystitis in Prostate and Bladder Cancer
Hemorrhagic cystitis (HC) is a complication of pelvic radiation with an estimated incidence of ≤5%. Incidence increases with time as symptomatic hematuria usually develops after 5 years. Despite improvements in radiation, series have shown significantly lower rates of gastrointestinal but not genitourinary toxicity. HC is a challenging problem for urologists as patients often require multimodal treatment. Morbidity and complications of the disease have yet to be fully assessed in the literature. We report the incidence, treatment and associated morbidity of HC after radiation therapy for prostate and bladder cancer at our institution.
We completed a retrospective chart review from January 2000-September 2015 in 788 patients who underwent radiation therapy for prostate or bladder cancer. In patients who developed HC, we analyzed the incidence, radiation modality, morbidity, treatment and complications.
From 2000-2015, 788 patients underwent radiation therapy for either prostate or bladder cancer. The incidence of HC was 10.4%. Radiation treatment included 52.4% external-beam radiation therapy (EBRT), 13.4% intensity-modulated radiation therapy (IMRT), 2.4% salvage radiation, mixed neutron/photon EBRT in 8.5% and IMRT in 3.7%, 7.3% ERBT with brachytherapy, 4.9% adjuvant radiation and 7.3% of patients had an unknown type. Patients developed HC an average of 70.3 months (4-300 months) after radiation. The average number of admissions was 2.6 (1-9) with an average length of stay of 7.3 days (1-42 days). 54.9% of patients required blood transfusion with an average of 4.6 units transfused (0-33 units). For treatment of HC, 86.4% of patients underwent cystoscopy for fulguration/clot evacuation and required an average of 2.6 cystoscopies (0-11). Other treatments included formalin (9.7%), alum (6.1%), silver nitrate (2.4%), amicar (11%), hyperbaric oxygen (11%) and urinary diversion (6.1%). Complications included UTI (30.5%), AKI (23.2), urethral stricture (14.6%), urosepsis (13.4%), hydronephrosis (4.9%), death (4.9%) and bladder rupture (3.7%).
Based on our results, the incidence of HC after radiation therapy for prostate or bladder cancer is under-reported in the literature. HC is associated with high morbidity for patients as it often requires multiple hospitalizations with long lengths of stay, blood transfusions, and multiple trips to the operating room. Complications range from infection to death and urologists need to educate their patients accordingly.