Radiation Cystitis - Causes, Grades, Symptoms, Diagnosis, and Treatment

What Is Radiation Cystitis?

Radiation cystitis is a medical term used to denote the inflammation and other complications that occur when radiation is passed to the body to treat cancer. Cystitis is a condition characterized by the inflammation of the urinary bladder. When this inflammation occurs due to radiation, it is known as radiation cystitis. When the cells in the bladder and other organs of the pelvis divide rapidly, they form a mass known as a tumor. This tumor is benign if it remains in the affected organ itself. However, when the tumor cells spread to the other organs, they turn malignant, resulting in cancer. Radiation therapy has proven to be an effective cancer treatment. However, complications occur when the radiation penetrates and damages the surrounding healthy organs. Some modifications have been made in the radiotherapy techniques to ensure the radiations remain confined to the tumor cells.

What Are the Causes of Radiation Cystitis?

Radiation therapy aims to deliver radiation to the cells that have divided rapidly and resulted in a tumor or cancer of a particular organ. The mechanism by which radiation therapy works against cancer is described below:

1. Under normal conditions, the radiation enters the body and transfers energy to the molecules present in the tumor cells.

2. They interact with the water present between the tumor cells and produce molecules that slow down the growth of the tumor cells.

3. The radiation also stops the cell division cycle by interfering with the synthesis of deoxyribonucleic acid (DNA).

4. When the cells fail to divide and continue their cycle, they die.

The problems arise when these effects are seen in healthy cells. Radiation cystitis occurs when the healthy bladder cells become damaged due to the radiation. The cells and the tissues of the bladder require a continuous supply of blood to function. Radiation interferes with the blood supply and blocks the blood vessels. As a result, the bladder cells remain devoid of oxygen and blood and fail to function. The tissues get damaged due to the harmful effects of ammonia present in the urine resulting in the inflammation of the bladder or cystitis.

What Are the Symptoms of Radiation Cystitis?

The patient might experience the symptoms of radiation cystitis immediately or later (after six months). The symptoms appear later because of the formation of ulcers and fistulae in the bladder. The symptoms of radiation cystitis are listed below:

1. Dysuria - A burning sensation while passing urine is also known as dysuria. It is a feeling that causes pain and discomfort while urinating, something that is not felt normally. The inflammation of the bladder lining due to radiation causes dysuria.

2. Urinary Frequency - The patient rushes to the bathroom repeatedly to pass urine. It is because the urine either leaks out or flows in small amounts resulting in incomplete emptying of the bladder.

3. Hematuria - In the initial stages of radiation cystitis, the blood is present in very small amounts in the urine and is visible only on the microscope. As the condition becomes severe, the amount of blood in the urine increases. Hematuria mainly occurs when the bladder lining gets damaged due to radiation.

4. Urinary Incontinence -Urinary incontinence, also known as the leaky bladder, is a condition in which urine leaks due to a lack of bladder control. The urine might leak out while coughing, sneezing, and exercising. In grade three and grade four radiation cystitis, the capacity of the urinary bladder to hold urine is only 100 to 150 milliliters. As a result, the urine flows out without the knowledge of the person resulting in urinary incontinence.

5. Hydronephrosis - It is a condition in which the kidneys swell due to the accumulation of urine. The urinary bladder gets damaged due to radiation and is unable to store urine.

6. Pneumaturia - The presence of bubbles in the urine is known as pneumaturia. The gas from the bowel gets mixed with the urine due to communication between the bowel and the bladder (fistula). Grade four radiation cystitis is usually characterized by a fistula.

7. Fecaluria - The presence of solid waste matter (fecal matter) in the urine is known as fecaluria. As a result, the urine appears cloudy and smells bad.

What Are the Different Grades of Radiation Cystitis?

Radiation cystitis can be divided into four stages or grades depending upon the severity. The grades have been described in the table below:

What Methods Are Used to Diagnose Radiation Cystitis?

The symptoms of radiation cystitis are similar to other diseases like urinary tract infections, kidney stones, and tumors. Therefore, a complete examination of the urinary system is required to rule out the other conditions. The diagnosis of radiation cystitis is based on a combination of laboratory tests and imaging tests. The methods used to diagnose radiation cystitis are listed below:

• Laboratory Tests - The following laboratory tests are usually recommended to rule out urinary tract infections:

  • Urinalysis - In this test, the patient urinates in a container, and this container is sent to the laboratory for examination. This test is mainly done to rule out urinary tract infections and to check the presence of bacteria and white blood cells in urine.

  • Urine Culture - The urine sample submitted by the patient is sent to the laboratory for examination. This test helps to identify the exact bacterial strain that caused an infection.

  • Urine Cytology Test - The patient collects urine in a container or a sterile bag. It is then examined by the pathologist under a microscope to check if cancer-causing cells are present in the urine.

  • Complete Blood Count (CBC) - This is the most commonly prescribed test if blood is present in the urine. The doctor recommends the patient undergo a complete blood count test to check the platelet count, hemoglobin concentration, and the number of red and white blood cells present in the body.

• Cystoscopy - In this procedure, a small telescope-like instrument known as the cystoscope is inserted into the bladder through the urethra. It helps to diagnose and treat problems of the urinary tract. The inner lining of the urinary bladder appears white and shows small blood vessels (telangiectasia) when viewed through a cystoscope.

• Ultrasound - In this procedure, the patient is laid on a table, and a gel is applied to the abdomen. The doctor rolls a device called the transducer probe over the abdomen, and the images of the urinary tract are obtained on the computer screen. These images help to detect the problems of the urinary bladder and other organs.

How Is Radiation Cystitis Managed?

The treatment of radiation cystitis depends upon the severity of the condition. The treatment options for radiation cystitis are listed below:

1. Pharmacologic Therapy - Grade one and grade two radiation cystitis do not require any surgical intervention. The following drugs can be recommended to help the patient get rid of the symptoms:

   • Anticholinergic Drugs - Oxybutynin, Tolterodine, and Darifenacin are usually recommended to treat urinary incontinence.

   • Analgesic - Phenazopyridine helps to control pain while passing urine.

   • Blood Thinner - Pentosan polysulfate sodium helps to reduce inflammation, control pain, and improve the inner lining of the urinary bladder.

2. Bladder Irrigation - Bladder irrigation is a procedure in which a special type of liquid is injected into the bladder to clean it. First, a tube known as a catheter is inserted into the urinary bladder. Next, the irrigating solution is passed through this tube into the bladder. This procedure helps to remove the blood clots formed in the bladder lining due to hematuria.

3. Hyperbaric Oxygen Therapy - In this procedure, the patient is allowed to breathe pure oxygen in a high-pressure environment. This therapy is usually done for 90 to 120 minutes, and the patient is required to undergo the therapy five days a week. So, a total of 40 to 50 sessions need to be attended. This therapy helps to restore the damaged bladder lining and allows the formation of new blood vessels. It is preferred by patients because it is a non-invasive procedure.

What Are the Complications of Radiation Cystitis?

The most severe complication of radiation cystitis is hemorrhagic cystitis. It is a condition in which the inner lining of the bladder becomes damaged, and the patient shows the presence of blood in the urine. If the radiation cystitis is left untreated for a long time, the cells and tissues of the bladder remain deprived of the blood supply resulting in necrosis and cell death. This causes blood clots to form in the urinary bladder. As a result, the flow of urine is hindered, and the patient experiences pain and a burning sensation while passing urine. The urinary bladder is unable to store urine after some time, and surgery might be required to treat the condition.

Conclusion:

Radiation cystitis is one of the common side effects of radiation therapy used to treat cancer. The healthy cells present in the bladder fail to divide when the radiation interferes with the genetic material present in them. There are four grades of the condition depending, upon the severity. In the initial stages, the patient requires only antibiotics, and the condition subsides after the symptoms are treated. The patient must check for the symptoms of the condition and consult the doctor at the earliest to avoid complications. Surgical intervention is not required if the condition is diagnosed and treated on time.