Treatment of cystitis - in which cases need hospitalization - Radiation cystitis

The treatment of radiation cystitis

Radiation cystitis - a common side effect of radiation therapy that develops due to partial damage to the cells of the bladder mucosa. Standard methods of medical treatment for radiation cystitis often do not apply by reason of non-infectious nature of the disease - treatment of radiation cystitis suggests specific procedures such as irrigation of the bladder using special solutions or hyperbaric oxygen (oxygen introduction into the bladder).

Most treatments for radiation cystitis, accompanied by hematuria (the appearance of a significant amount of blood in the urine) is aimed at suppressing the symptoms. An exception is the hyperbaric oxygen therapy - a non-invasive method of treatment of radiation cystitis, potentially able to compensate for the damage caused by radiation therapy. However, when significant ischemia and fibrosis of the bladder, caused by radiation therapy, hyperbaric oxygen therapy is not conducive to recovery muchevogo bladder and only prevent further destruction of cells.

If symptoms of radiation cystitis do not threaten human health, but cause discomfort enough to seek medical help at the first stage of treatment is assigned to pentosan polysulfate sodium and, at the same time, pentoxifylline, facilitates pain .  Pentosan polysulfate sodium helpful in treating radiation cystitis in early stages in seventy percent of the cases, while the chance of re-emergence of symptoms is not more than twenty-three percent .  Pentosan polysulfate sodium protects the transitional epithelium, restoring glycosaminoglycan layer of the bladder wall .  The recommended dosing regimen for adults is one hundred milligrams orally to complete disappearance of symptoms (at least four weeks) .  Pentoxifylline (Trental) effectively suppresses pain associated with radiation fibrosis .  The drug and its active substances reduce the viscosity of the blood by stimulating blood flow to damaged areas of bodies and, thus, the oxygen saturation of cells .  The recommended dose for adults is pentoxifylline four milligrams orally for six weeks .

If symptoms become acute or oral drugs are not effective for the treatment of radiation cystitis used hyperbaric oxygen therapy or irrigation. Irrigation of the bladder (bladder introduction of special solutions) with a solution of alum, aminocaproic acid or formalin is indicated for significant bleeding, caused by radiation cystitis.

Hyperbaric oxygen therapy for the treatment of radiation cystitis

Ray hemorrhagic cystitis can develop into a period of two months to ten years after exposure to radiation in the pelvic area. In one study, it was found that of the 1784 patients who were under radiotherapy treatment of cervical cancer, hemorrhagic cystitis, radiation developed in 6.5% of cases.

Another study suggests that the radiation cystitis Cystitis: urgently take action   and moderate or severe hematuria occur in 3-5% of patients receiving radiotherapy for the treatment of prostate cancer. Normally, primarily for the treatment of radiation cystitis is assigned bladder irrigation with saline; as there are special procedures to stop the bleeding, because of which there is hematuria. In some cases it may be recommended oral or intravenous administration of amino caproic acid, estrogens and other drugs. If this does not help, for irrigation can be used silver nitrate, prostaglandins or formalin. In the most severe cases, to resort to a selective embolization of the arteries and cystectomy.

However, before you use the most radical methods of treatment, the doctor may refer the patient to the hyperbaric oxygenation (HBO). The benefits of this method in the treatment of radiation cystitis started talking several decades ago. HBO stimulates the healing process of damaged tissue, reduces swelling, increases the concentration of fibroblasts Fibroblasts: the mystery of the connective tissue   and, in general, a beneficial impact on the areas of the body exposed to the radiation. Despite this, experts only recently begun to explore the possibility of using HBOT in the treatment of radiation cystitis.

Research

Four men and three women (ages 21 to 80 years) were hyperbaric oxygenation, which was assigned to them for the treatment of hemorrhagic radiation cystitis. Men who participated in the study, with the help of previously treated with ionizing radiation prostate cancer in women - metastatic breast cancer, cervical cancer, and primitive neuroectodermal tumor. All patients underwent local radiotherapy, that is, the radiation impacted only on the part of the body where the tumor was located. In some patients, after treatment with a sharp decrease in hemoglobin levels, and they had to do a blood transfusion.

Before the start of HBO six of the seven patients did cystoscopy and biopsy to rule out the presence of malignancy. In all cases the biopsy showed histological changes, which are often accompanied by cystitis ray. To rule out other irregularities in the examination of patients before treatment were used cystoscopy, ureteroscopy and urine cytology.

results

Subjects were hyperbaric oxygenation for 90 minutes a day, in a multi-pressure chamber. All patients were scheduled to go to the procedure 5 times a week (on weekdays), and each patient underwent an average of 30 HBO treatments (minimum - 18 maximum - 57). Doctors closely monitor changes in the condition of patients throughout the course of treatment.

All seven of the subjects at the end of therapy was observed complete recovery or significant improvement .  Two patients soon resumed hematuria .  One of them was 30, other - 37 additional procedures of GMO, then hematuria and other symptoms of radiation cystitis completely disappeared .  All subjects except one, before GM made cystoscopy to rule out other possible causes of bleeding from the bladder, in addition to radiation cystitis .  These patients underwent cystoscopy and after HBO - this time to ensure that doctors can visually assess the results of treatment .  In all cases, there was significant improvement in bladder mucosa .  One patient (a woman aged 21, held radiotherapy for the treatment of primitive neuroectodermal tumor), radiation cystitis symptoms disappeared after only 20 sessions of HBO, but she died three months after cessation of treatment, due to the underlying disease .

Discussion of Results

Under the influence of ionizing radiation is disturbed collagen production significantly slows down the process of cell renewal, leading to tissue damage. Moreover, tissue damaged by radiotherapy, usually can not recover on their own and in full. Radiation cystitis and hematuria due to concomitant injury of the bladder mucosa and blood vessels that are found in its walls. With cystoscopy can detect signs of damage, even if there are no symptoms of radiation cystitis.

The patient goes hyperbaric oxygenation in a state of rest, breathing pure oxygen, and being in the chamber, where the air pressure above atmospheric pressure in 1.4-3 times.

During his stay in the chamber into the human body through the respiratory tract and the skin gets a very large amount of oxygen, resulting in its concentration in blood plasma increases considerably. This saturation of the tissues of oxygen can not be achieved by any other methods that are currently used in medical practice. HBO is widely used in the treatment of various diseases; this therapy improves the efficacy of certain antibiotics, stimulates the formation of collagen fibers, accelerates healing of tissues, and also has other beneficial properties already mentioned above.

Because of these properties HBO is effective in the treatment of radiation cystitis - it helps to restore damaged tissue radiotherapy urinary organs. This procedure is also to some extent improves the functioning of the immune system.

After the end of the study, which was discussed above, the doctors observed the subjects for four years; none of them had a relapse of radiation cystitis.

In earlier studies, 82% of patients receiving HBOT in the treatment of radiation hemorrhagic cystitis, persistent improvement occurred. HBO was the most effective for those who have observed the least severe form of the disease. 2, 5 years of observation after treatment in three of eleven patients did not appear any signs of radiation cystitis. Within five years, a relapse occurred in eight of the eleven patients. In some cases needed hospitalization, blood transfusions, and the use of more invasive treatment of radiation cystitis than GMOs. The possibility of using HBOT for the treatment of relapse has not been studied yet.

Patients in the hyperoxia diabetes can sharply reduce the concentration of glucose in the blood - the reasons why this happens is unclear. To make this side effect is less pronounced during treatment is necessary to monitor changes in blood glucose, and to take timely measures to normalize it. Be especially careful to watch for patients who have a history emphysema, spontaneous pneumothorax Pneumothorax - when help is needed immediately And other obstructive pulmonary diseases.

Ray hemorrhagic cystitis Hemorrhagic Cystitis: always seriously   - One of the painful complications of radiotherapy. Standard treatments are often powerless against this disease, and sometimes cause serious side effects. HBO is a safe non-invasive treatment of radiation cystitis, which leads to a lasting improvement in a substantial proportion of patients.

On the basis of currently available scientific data, scientists have concluded that the best course of treatment of radiation cystitis consists of 40 HBO treatments. Some experts believe that HBO should take place among the varieties of first-line therapy for the treatment of radiation cystitis, as in many cases, it helps to avoid surgery.