Radiation Cystitis (Radiation injury to the bladder)

This 85 year old male patient was referred by his urologist to Wesley Hyperbaric suffering the effects of radiation cystitis.

The patient was initially admitted to the emergency department complaining of urinary retention, pain and blood in the urine. CT scans suggested cystitis related to recent radiotherapy.

The patient was taken to theatre for bladder washout, biopsy and diathermy. The biopsy was consistent with radiation cystitis.

After returning to the ward with continuous bladder irrigation and blood transfusions, various treatment options were discussed, including chemical cauterisation, Intravescicular Alum and Hyperbaric Oxygen Therapy.

A return to theatre 3 days later resulted in a bladder washout to expel more clots. Ulcerated and necrotic areas could be seen within the bladder and bilateral ureteric catheters were inserted. He returned to the ward with continuous Alum bladder irrigation and further blood transfusions.

2 weeks after initial hospital admission and 3 days post surgery, hyperbaric oxygen therapy was commenced. At that time continuous bladder irrigations continued with large clots and blood draining. The possibility of ureteric diversion and cystectomy were discussed if hyperbaric oxygen therapy was not effective.

On assessment at Wesley Hyperbaric, it was noted that the patient also averaged 9 – 15 blood stained bowel movements a day, a symptom which he had grow to live with.

Hyperbaric treatment was commenced, consisting of 40 daily sessions, each taking just under 2 hours, Monday to Friday.

Image of normal internal bladder surface
Image of normal internal bladder surface
Abnormal bladder wall in Radiation Cystitis
Abnormal bladder wall in Radiation Cystitis

 

 

 

 

 

A decrease in blood staining of the urine was noted after 2 weeks. However a further return to theatre was required 11 days into hyperbaric oxygen therapy due to further bleeding. Clots were evacuated with bleeding found to be due to oozing biopsy sites.

With no further adverse events, the indwelling urinary catheter was removed on day 26 of
treatment and the patient discharged from hospital after 31 hyperbaric sessions.

He continued to complete his 40 sessions on an outpatient basis.

At his 6 week follow up he reported significant improvement in urinary symptoms. By 6 months this had completely resolved. He also stated his bowel frequency had been markedly reduced from 9 movements/day to 4/day. He was no longer experiencing pain and reported being very satisfied with the outcome.