The clinical study of five-step sequential method for the treatment of hemorrhagic radiation cystitis

Objective To investigate the clinical effect of five-step sequential method for hemorrhagic radiation cystitis. Methods From April 2015 to April 2018, 512 cases of hemorrhagic radiation cystitis patients in 6 provincial tumor hospital were retrospectively analyzed. 12 cases were male patients, and 497 cases were female. Patients' average age was (60.1 ±8.2) years (53-71 years). Hematuria appeared in 2.9 years on average after radiotherapy(ranged 0.5 to 13 years). According to the severity of hematuria, 480 patients were classified as mild and 32 patients as severe. The step 1 was drug conservative symptomatic treatment. Thrombin solution or sodium hyaluronate was used for bladder perfusion in step 2.The step 3 was transurethral electrocoagulation.The step 4 was interventional embolization. The step 5 was hyperbaric oxygen therapy. Mild patients were treated from the first step, and the severe patients were treated from step 3, and combined with step 1. Overactive bladder symptom score (OABSS) was used to assess the improvement of patients' symptoms. Results No obvious complications occurred in step 1, 2, 3, 5. Mild hip pain occurred at step 4. Recurrent hemorrhage rate were 6.7%(2/30)in mild patients group and 10.5%(2/19)in severe respectively in step 4. The total effective rate of step 1 in mild patients group was 65.2%(313/480), step 1+ 2 was 84.2%(404/480), step 1+ 2+ 3 was 95.6% (459/480), step 1+ 2+ 3+ 4 was 98.3% (472/480), and step 1+ 2+ 3+ 4 + 5 was 100%(480/480). The effective rate of step 3+ 1 treatment was 59.4%(19/32)in severe patients group, step 3+ 1+ 4 was 68.8%(22/32), and step 3+ 1+ 4+ 5 was 100%(32/32). The OABSS scores of mild and severe patients decreased after treatment(P<0.01). Conclusion Five-step sequential therapy could be an effective method for the treatment of hemorrhagic radiation cystitis. Key words: Radioactive cystitis; Transurethral electrocoagulation; Intervene embolize therapy; Hyperbaric oxygen