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Keywords:

  • hyaluronic acid;
  • hyperbaric oxygen;
  • hemorrhagic cystitis;
  • radiation

Study Type – Therapy (RCT)

Level of Evidence 1b

What's known on the subject? and What does the study add?

Hemorrhagic cystitis (HC) is a relatively rare bladder disease with a complex etiology. With the growing number of patients with pelvic radiation therapy, incidence of this disease has risen considerably. Although treatments like hyperbaric oxygen (HBO) had some benefit to improve the symptoms, the optimal treatment of this disease still remains a tough problem.

We reported our experience of intravesical hyaluronic acid (HA) and HBO in treating HC and the results seemed interesting. Intravesical HA is easier to do and well tolerated, and it showed a sustained decrease of bladder bleeding, pelvic pain and frequency of voiding for at least 12 months. We suggest it as an alternative and potential way in treating HC.

OBJECTIVE

  • • 
    To compare the efficacy of intravesical hyaluronic acid (HA) instillation and hyperbaric oxygen (HBO) in the treatment of radiation-induced haemorrhagic cystitis (HC).

PATIENTS AND METHODS

  • • 
    In total 36 patients who underwent radiotherapy for their pelvic malignancies and subsequently suffered from HC were randomly divided into an HA group and an HBO group.
  • • 
    Symptoms of haematuria, frequency of voiding and the visual analogue scale of pelvic pain (range 0–10) were evaluated before and after the treatment with follow-up of 18 months.

RESULTS

  • • 
    All patients completed this study and no obvious side effects of intravesical HA were recorded.
  • • 
    The improvement rate showed no statistical difference between the two groups at 6, 12 and 18 months after treatment.
  • • 
    Decrease of frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy.
  • • 
    The improvement in the visual analogue scale remained significant in both groups for 18 months.

CONCLUSIONS

  • • 
    Intravesical instillation of HA was as effective in treating radiation-induced HC as HBO.
  • • 
    It is well tolerated and resulted in a sustained decrease of bladder bleeding, pelvic pain and frequency of voiding for at least 12 months.