Radiation Cystitis
Late-onset bladder damage in women following pelvic radiotherapy for cervical, endometrial, or rectal cancers, causing chronic inflammation and bleeding.
Overview
Radiation Cystitis develops as a late complication of pelvic radiotherapy, typically months to years after treatment. Radiation damages the urothelium and submucosal vasculature, leading to mucosal atrophy, fibrosis, telangiectasia formation, and chronic haemorrhage. It is frequently underdiagnosed in women during gynaecological oncology follow-up.
Key Symptoms
- Haematuria — microscopic or gross, often persistent
- Urinary urgency and frequency
- Suprapubic pain and discomfort
- Reduced bladder capacity
- Recurrent UTI-like symptoms without confirmed infection
Pathophysiology
Radiation induces obliterative endarteritis of submucosal vessels, causing progressive ischaemia, mucosal atrophy, and fibrosis. Telangiectatic vessels are fragile and bleed easily, perpetuating the haematuria cycle.
Treatment Approach
Hyperbaric oxygen therapy, intravesical instillations (PPS, hyaluronic acid), haemostatic agents, and in severe cases, endoscopic fulguration of bleeding vessels. Elmiron (PPS) supports GAG layer repair.