Radiation cystitis: Acute and chronic

Abstract

Radiotherapy (RT) is a standard treatment option and an essential component of multimodal organ sparing treatment for various malignancies in the pelvis including cancers of the prostate, uterine cervix, rectum, and urinary bladder. Malignancies originating in these organs constitute up to 18% of all cancers. Due to its anatomic location, the urinary bladder is frequently exposed to radiation during treatment for pelvic cancers giving rise to a variety of urinary adverse effects. The acute effects of radiation on urothelium are characterized by mucosal edema, hyperemia, and inflammation. Acute lower urinary tract symptoms due to radiation can be irritative or obstructive. Irritative symptoms include urinary frequency, urgency, dysuria, and nocturia. Obstructive symptoms include weak urinary stream, hesitancy, and incomplete bladder emptying or complete bladder obstruction. Late damage is irreversible and is characterized by epithelial denudation, and ulceration with focal hyperplasia and fibrosis. In contrast to acute toxicity, late manifestations tend to be chronic and irreversible. Patients with a severely contracted bladder present with debilitating urinary frequency and incontinence. Another chronic manifestation of pelvic RT is late recurrent hematuria or hemorrhagic cystitis, defined as acute or insidious diffuse vesical bleeding that can sometimes be life threatening. A variety of scoring systems have been developed to assess the severity of bladder damage from radiation injury.