Urology

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Browsing Urology by Subject "Cystitis -- Treatment"

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    HORTIS-III: Radiation cystitis - a multicenter, prospective, double-blind, randomized, sham-controlled trial to evaluate the effectiveness of hyperbaric oxygen therapy in patients with refractory radiation cystitis
    (Stellenbosch : Stellenbosch University, 2010) Smit, S. G.; Heyns, C. F.; Cronje, F. J.; Roberts, C. J.
    Objective: Hyperbaric oxygen therapy (HBOT) for refractory late radiation cystitis has been reported with success rates of 60% to 92%. HORTIS (Hyperbaric Oxygen Radiation Tissue Injury Study) is a multicenter study conducted by the Baromedical Research Foundation, South Carolina, USA. Tygerberg Hospital and University of Stellenbosch is one of 6 centers recruiting patients for the radiation cystitis arm (HORTIS-III). Methods: Patients were prospectively randomized: Group A (treatment) received HBOT (100% oxygen at 2.0 atmospheres). Group B (control) received sham treatment (21% oxygen at 1.0 atmosphere). Patients and referring physicians were blinded to the randomization process. Patients received 30-40 sessions of either HBOT or sham treatment. After unblinding, patients in the control group were offered crossover to the treatment group. Primary outcome measures included clinical evaluation, SOMALENT and EPIC scores. Results: In total, 34 patients were screened, 5 met the inclusion and exclusion criteria and agreed to participate. Two patients were randomized to Group A. One patient received 30 sessions of HBOT. One patient absconded after 26 sessions of HBOT. Three patients were randomized to Group B and received 40 sessions of sham treatment. All 3 control patients elected to cross over: two patients completed 40 sessions of HBOT, one stopped at 24 sessions due to an unrelated medical condition (critical limb ischemia). No serious adverse events occurred. At 14 months follow-up after HBOT, 3 patients showed improvement in SOMALENT and EPIC scores. One patient with a vesicovaginal fistula showed complete radiographic resolution at 14 months follow-up. In total, 13 patients have been recruited internationally. Conclusion: HBOT remains a treatment option for refractory late radiation cystitis. The evidence presented is inconclusive due to the low number of patients, but the ongoing multicenter trial is expected to provide conclusive evidence.
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    Management of radiation cystitis
    (Nature Publishing Group, 2010-04) Smit, Shaun G.; Heyns, Chris F.
    Acute radiation cystitis occurs during or soon after radiation treatment. It is usually self-limiting, and is generally managed conservatively. Late radiation cystitis, on the other hand, can develop from 6 months to 20 years after radiation therapy. The main presenting symptom is hematuria, which may vary from mild to severe, life-threatening hemorrhage. Initial management includes intravenous fluid replacement, blood transfusion if indicated and transurethral catheterization with bladder washout and irrigation. Oral or parenteral agents that can be used to control hematuria include conjugated estrogens, pentosan polysulfate or WF10. Cystoscopy with laser fulguration or electrocoagulation of bleeding points is sometimes effective. Injection of botulinum toxin A in the bladder wall may relieve irritative bladder symptoms. Intravesical instillation of aluminum, placental extract, prostaglandins or formalin can also be effective. More-aggressive treatment options include selective embolization or ligation of the internal iliac arteries. Surgical options include urinary diversion by percutaneous nephrostomy or intestinal conduit, with or without cystectomy. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at higher than atmospheric pressure. The reported success rate of HBOT for radiation cystitis varies from 60% to 92%. An important multicenter, double-blind, randomized, sham-controlled trial to evaluate the effectiveness of HBOT for refractory radiation cystitis is currently being conducted. © 2010 Macmillan Publishers Limited. All rights reserved.