Early fulguration may be best for radiation cystitis

Tokyo-Early transurethral fulguration (TUF) may be a reasonable option for treatment of severe hemorrhagic radiation cystitis, according to Japanese urologists.

In a retrospective study that included 283 patients hospitalized with grade 4 hemorrhagic radiation cystitis, the authors found using multiple analyses that patients treated by TUF early after admission (within 4 days) had a significantly shorter length of stay than patients treated by TUF 5 to 21 days after admission or who were managed conservatively with observation (no TUF within 21 days).

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“Despite its severity, there is very little evidence on the management of hemorrhagic radiation cystitis. The findings of our study support early intervention with TUF,” said first author Toru Sugihara, MD, MPH, assistant professor of urology at the University of Tokyo.

The patients included in the study were identified from the Japanese national hospitalization database as being hospitalized during the years 2007 to 2012 for radiation cystitis and receiving a transfusion within 3 days of admission. Of the 283 patients, 65 (23%) received TUF within 4 days of admission, 32 (11.3%) were treated by TUF between days 5 and 21 post-admission, and 186 (65.7%) patients did not receive TUF within the first 21 days after they were hospitalized.

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Median length of stay was 11 days in the early TUF group and nearly twice as long-20 days-in both the late TUF and observation groups (p=.003), Dr. Sugihara reported at the 2015 AUA annual meeting in New Orleans. Kaplan-Meier analysis of discharge event showed a statistically significant difference comparing the early TUF and observation groups (p<.01) and a nearly statistically significant difference comparing the early TUF and late TUF groups (p=.06).

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A multivariate analysis of discharge was also conducted using a Cox proportional hazard model controlling for gender, age, comorbidity, and use of hyperbaric oxygen therapy. The results again favored the early TUF group for having an earlier discharge compared with both the late TUF group (hazard ratio 0.65; p=.048) and the observation group (hazard ratio 0.69, p=.014).

“We also found that treatment with hyperbaric oxygen was associated with delayed discharge, which may be explained by the fact that it involves 20 to 40 sessions,” Dr. Sugihara said.