What is Radiation Cystitis and Hyperbaric Management?
Radiation Cystitis is a condition that happens when the bladder becomes inflamed as a side effect of radiation treatment for certain types of cancer, most commonly those situated in the pelvic area. This radiation therapy might be used to treat bladder cancer itself or tumors in neighboring organs, like the colon, rectum, ovaries, uterus, and prostate. However, when the original tumor isn’t in the bladder, healthy bladder tissue might get unintentionally exposed to the radiation.
This radiation exposure can lead to damage in the bladder cells, either happening quite quickly (within six months of treatment) or developing slowly (more than six months after treatment). This damage can cause irritation and malfunctions in the lining of the bladder. If the damage is minor, symptoms might include needing to urinate more often, feeling a sudden urge to urinate, and potentially some pain during urination. Doctors will need to make sure these symptoms are not due to an infection by performing a urinalysis, which might reveal small amounts of blood in the urine. Fortunately, these symptoms can get better with time.
On the more severe side, patients might experience symptoms like urinary incontinence, visible blood in the urine, and even more serious damage leading to the development of abnormal connections between organs (known as fistulas) or dead bladder tissue. The treatment approach will depend on the severity of symptoms. Radiation Cystitis can negatively impact a patient’s quality of life, especially since they’ve already had to cope with cancer treatment.
Healthcare providers are becoming more conscious of the significant impact a dysfunctional bladder can have on a person’s life. However, more research is needed to better design radiation therapy plans that minimize side effects like this one.
What Causes Radiation Cystitis and Hyperbaric Management?
Radiation is used in cancer treatment because it disrupts the process of DNA creation and stops cancer cells from dividing quickly. However, it can also affect healthy cells around the tumor in the same way. Additional effects of radiation include reducing the blood supply to the area being treated. It does this by causing swelling and scarring, which can lead to the blood vessels becoming blocked (known as obliterative endarteritis). When this happens, it can cause tissue that relies on these vessels to die off.
Risk Factors and Frequency for Radiation Cystitis and Hyperbaric Management
The occurrence of radiation cystitis, a condition caused by radiation therapy, varies according to different studies. Typically, it’s estimated that 5% to 10% of patients experience delayed effects of radiation, with severe blood in urine happening in 5% to 8% of cases. The discrepancy in these percentages is due to factors such as the type and extent of the cancer, the kind of radiation used, and the total amount of radiation administered.
- The symptoms of radiation cystitis usually start around 31.8 months after the radiation therapy ends.
- It’s more frequent in males than females, with a ratio of about 2.8 to 1.
Signs and Symptoms of Radiation Cystitis and Hyperbaric Management
After undergoing radiation therapy, patients may immediately experience frequent urination, an urgent need to urinate, painful urination, and blood in the urine (visible or not). However, other symptoms can develop months or years later due to scarring. These long-term effects can include the inability to control urination, kidney damage, sores in the urinary tract, and abnormal connections between organs (fistulas). It’s important to realize that everyone’s experience with radiation therapy can be different and not all patients will experience these symptoms.
- Immediate urination frequency
- Urgent need to urinate
- Painful urination
- Blood in the urine (visible or not)
- Long-Term: Inability to control urination
- Long-Term: Kidney damage
- Long-Term: Sores in the urinary tract
- Long-Term: Abnormal connections between organs (fistulas)
Testing for Radiation Cystitis and Hyperbaric Management
The severity of symptoms for certain diseases is measured using a ranking system developed by the Radiation Therapy Oncology Group (RTOG). This system breaks down severity into four grades:
* Grade 1: Signs of skin damage or thinning, tiny, dilated blood vessels (telangiectasia), and non-visible blood in the urine (microscopic hematuria).
* Grade 2: Moderate need to urinate or large-scale telangiectasia, occasional visible blood in the urine (intermittent macroscopic hematuria), and occasional inability to control urination (intermittent urinary incontinence).
* Grade 3: Severe need to urinate frequently or urgent need to urinate, severe telangiectasia, constant incontinence, reduced bladder capacity below 150 mL, and frequent visible blood in the urine (hematuria).
* Grade 4: Tissue death (necrosis), abnormal connection between organs (fistula), painful bladder inflammation with bleeding (hemorrhagic cystitis), reduced bladder capacity below 100 mL, uncontrollable incontinence requiring a catheter or surgery.
When evaluating symptoms related to urination, the primary focus is on ruling out common causes. Tests on your urine (urinalysis) for culture and cytology are the first steps to exclude bacterial infection and cancer. If you’ve experienced visible blood in your urine (hematuria), a complete blood count (CBC) will be required to check hemoglobin, white blood cell, and platelet counts.
If the presence of larger amounts of blood in your urine is confirmed, additional testing will be needed to determine the body’s overall fluid status, and coagulation tests including prothrombin time (PT) and activated partial thromboplastin time (aPTT) will be given. Your kidney function will also be checked, meaning a chemistry panel will be ordered to look at your levels of electrolytes, BUN (a waste product in the blood), and creatinine (a measure of kidney function).
To get a better understanding of any potential damage, your doctor might recommend a cystoscopy (an examination of the bladder cavity with a thin, lighted tube) and a renal ultrasound (an imaging technique which paints a picture of your kidneys using sound waves). When performing a cystoscopy, your doctor may find white patches of skin-like tissue in your bladder with a cluster of tiny, dilated blood vessels (telangiectasia).
Treatment Options for Radiation Cystitis and Hyperbaric Management
Radiation cystitis is a condition that may develop following radiation treatment for cancer in the pelvic area. The treatment for this condition depends on how severe your symptoms are.
When people have mild symptoms (grade 1 or 2), they typically only need treatments to help control these symptoms. If you go to the toilet more frequently or urgently than usual, you might find relief from certain medications commonly referred to as anticholinergics. Doctors also often recommend ‘bladder irrigation’ which essentially involves cleaning out the bladder, especially if there are clots due to bleeding (known medically as hematuria). Sometimes, they might also use special substances (like alum or silver nitrate) inside the bladder to help stop any bleeding.
In recent years, a therapy called Hyperbaric Oxygen Therapy (HBOT) has become more popular. This non-invasive treatment not only helps to manage symptoms, but it can also potentially stop the condition from progressing. During HBOT, you would breathe in oxygen under higher than normal pressure conditions. This treatment can help stimulate the formation of new blood vessels, improving blood flow to areas that might have been damaged by the radiation, and thus help preserve bladder function. The success rate of this therapy varies, but in some studies, it’s been seen to completely resolve the condition in 27% to 100% of patients, with most studies showing more than 75% of people seeing a complete resolution of symptoms.
One such study indicated that patients who received the treatment within six months after the start of blood in the urine had a 96% rate of getting complete or partial resolution of their symptoms. This dropped to a 66% response rate if the treatment was started after six months. So, the sooner this therapy is started, the better.
In cases where the disease is either severe or not responding to less invasive treatments, more aggressive treatments may be considered. This may be necessary if you have continued bleeding, abnormal connections (fistulas), severe muscle contractions of the bladder, or swelling due to a built-up of urine (hydronephrosis). If these treatments also fail, the last resort may be a cystectomy, which involves removing part or all of the bladder. However, this is linked with high risk of complications and even death; almost half (42%) of patients have severe complications, and 16% die within 90 days.
What else can Radiation Cystitis and Hyperbaric Management be?
Some of the conditions that can have symptoms similar to appendicitis, and should not be overlooked, include:
- Adhesions (scarring) from previous surgeries
- Degenerative joint disease (a type of arthritis)
- Diverticulitis (inflammation in the digestive system)
- Dysfunctional voiding (problems with urination)
- Gastrointestinal neoplasm (tumors in the digestive system)
- Hernia (a condition where an organ pushes through the wall that contains it)
- Inflammatory bowel disease (chronic inflammation in the digestive tract)
- Pelvic floor myalgia (muscle pain in the pelvic floor)
- Vulvodynia (chronic pain in the vulva)