Development of a Management Algorithm for Acute and Chronic Radiation Urethritis and Cystitis.

Autor:	Vanneste BGL; Department of Radiation Oncology (MAASTRO clinic), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands., Van Limbergen EJ; Department of Radiation Oncology (MAASTRO clinic), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands., Marcelissen TA; Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands., van Roermund JGH; Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands., Lutgens LC; Department of Radiation Oncology (MAASTRO clinic), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands., Arnoldussen CWKP; Department of Radiology and Nuclear Medicine, VieCuri Medical Centre, Venlo, The Netherlands., Lambin P; The D-Lab, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands., Oelke M; Department of Urology, St. Antonius Hospital, Gronau, Germany.
Jazyk:	angličtina
Zdroj:	Urologia internationalis [Urol Int] 2022; Vol. 106 (1), pp. 63-74. Date of Electronic Publication: 2021 Jun 15.
DOI:	10.1159/000515716
Abstrakt:	Objective: The purpose of this review was to summarize the current literature on the assessment and treatment of radiation urethritis and cystitis (RUC) for the development of an evidenced-based management algorithm. Material and Methods: The PubMed/MEDLINE database was searched by a multidisciplinary group of experts in January 2021. Results: In total, 48 publications were identified. Three different types of RUC can be observed in clinical practice: inflammation-predominant, bleeding-predominant, and the combination of inflammation- and bleeding-RUC. There is no consensus on the optimal treatment of RUC. Inflammation-predominant RUC should be treated symptomatically based on the existence of bothersome storage or voiding lower urinary tract symptom as well as on pain. When bleeding-predominant RUC has occurred, hydration and hyperbaric oxygen therapy (HOT) should be used first and, if HOT is not available, oral drugs instead (sodium pentosane polysulfate, aminocaproic acid, immunokine WF 10, conjugated estrogene, or pentoxifylline + vitamin E). If local bleeding persists, focal therapy of bleeding vessels with a laser or electrocoagulation is indicated. In case of generalized bleeding, intravesical installation should be initiated (formalin, aluminium salts, and hyaluronic acid/chondroitin). Vessel embolization is a less invasive treatment with potentially less complications and good clinical outcomes. Open- or robot-assisted surgery is indicated in patients with permanent, life-threatening bleeding, or fistulae. Conclusions: Treatment of RUC, if not self-limiting, should be done according to the type of RUC and in a stepwise approach. Conservative/medical treatment (oral and topic agents) should primarily be used before invasive (transurethral) treatments. (© 2021 The Author(s) Published by S. Karger AG, Basel.)
Databáze:	MEDLINE
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