Pathogenetic therapy as a way to restore the bladder tissue barrier in late onset post-radiation cystitis

Introduction. No standard of care therapy is currently available for patients with radiation-induced cystitis. Several approaches to symptomatic treatments are considered.
Aim. To evaluate histological, immunochemical, and electron microscopic findings on bladder ultrastructure in patients with late onset radiation cystitis (LRC).
Materials and methods. The study included 136 patients aged 30–68 years with late onset radiation cystitis, which developed as a complication of the concurrent radiation therapy due to cervical cancer. In addition to routine examinations, 48 patients underwent plain urethrocystoscopy with bladder wall biopsies taken from the most conspicuous lesions, followed by morphological and immunohistochemical examination of the biopsy specimens. Patients were randomized into a comparison group (CG, n = 104), which received standard symptomatic drug therapy, and a treatment group (TG, n = 32), which received identical symptomatic therapy and instillations with a viscoelastic protector of urinary bladder mucosa containing 50 ml of hyaluronic acid solution, which were administered twice weekly for two months. Immediate treatment outcomes were evaluated at the end of the two-month course, and the long-term outcomes were evaluated a year after the combination therapy.
Results. We found a highly statistically significant (p < 0.001) improvements in symptoms (relief of pain, urgency, hematuria) of LRC after the therapy. Cystoscopy also confirmed the statistically significant superiority of treatment outcomes in the TG patients: they demonstrated significantly lower rates of hyperemia, mucosal edema, angioectasias, and urothelial erosions. Unlike the CG, the patients receiving instillations with the viscoelastic protector of urinary bladder mucosa showed no mucosal ulcers after a two-month course of therapy.
Conclusions. The standard symptomatic treatment supplemented by bladder instillations with the viscoelastic hyaluronic acid protector of urinary bladder mucosa eliminates clinical and laboratory manifestations of bladder inflammation and reduces the frequency of relapses by 1.5 times in women with late onset radiation cystitis during the 1-year follow-up period.

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