I don't recall Radiation Cystitis being discussed here.
"Objectives: To elucidate the national burden of emergency department (ED) visits for radiation cystitis (RC), a known complication of radiation therapy to the pelvic area, among patients with a prostate cancer history ..."
"This {U.S.} study queried the Nationwide Emergency Department Sample for all ED visits from January 2006 to December 2015 with a primary diagnosis of radiation cystitis and secondary diagnosis of prostate cancer."
"A weighted total of 17,382 ED visits occurred for RC among patients with a prostate cancer history, of which 9,655 (55.5%) were treated with an invasive procedure."
One more thing I have to be thankful for on turkey day - that I was spared a day in ER hell with radiation cystitis.
. 2021 Nov 22. doi: 10.1111/bju.15650. Online ahead of print.
Emergency Department Visits for Radiation Cystitis Among Patients with a Prostate Cancer History
Victor Lee 1 , Yi An 1 , Henry S Park 1 2 , James B Yu 1 2 , Simon P Kim 3 , Vikram Jairam 1 2
Affiliations collapse
Affiliations
1 Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
2 Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.
3 Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
PMID: 34806813 DOI: 10.1111/bju.15650
Abstract
Objectives: To elucidate the national burden of emergency department (ED) visits for radiation cystitis (RC), a known complication of radiation therapy to the pelvic area, among patients with a prostate cancer history, and identify those who are at increased risk of requiring invasive measures.
Methods: This study queried the Nationwide Emergency Department Sample for all ED visits from January 2006 to December 2015 with a primary diagnosis of radiation cystitis and secondary diagnosis of prostate cancer. ED visits were characterized by demographic factors, socioeconomic factors, and hospital characteristics. Weighted frequencies were used to create national estimates for all data analysis.
Results: A weighted total of 17,382 ED visits occurred for RC among patients with a prostate cancer history, of which 9,655 (55.5%) were treated with an invasive procedure. Notable factors associated with undergoing an invasive procedure included having a prior prostatectomy (odds ratio [OR], 5.48; 95% confidence interval [CI], 2.62-11.46), urinary retention (OR, 1.35; 95% CI, 1.12-1.64), hematuria (OR, 1.20; 95% CI, 1.01-1.42), and undergoing a blood transfusion (OR 2.12; 95% CI, 1.72-2.62). ED visits that were associated with invasive procedures had a higher median total charge ($34,707.53 vs $15,632.53) and an increased median length of stay (5 days vs 3 days) compared to visits without an invasive procedure.
Conclusions: Among ED visits for RC in prostate cancer, approximately one half required an invasive procedure for treatment. While radiation remains an effective modality for patients with prostate cancer, providers should be mindful of RC as a potential complication.
Perfect timing sir. I just got out of the hospital where I was treated for radiation cystitis. When I had my salvage radiation in 2012 the ancient, time-serving radiation onc at the hospital never told us to have a full bladder (it was only later I started taking charge myself of my PCa treatment). A couple of years ago I started having episodes of hematuria, including twice when the clots jammed my urethra and required ER visits to clear. The second time I stayed in the hospital a few days before they could clear it. This time I spent six weeks with major hematuria every time I peed. Urologist tried finasteride, which did nothing, though the last couple of weeks the blood flow seemed a little lighter. So in for another full irrigation, which did not help, and then they tried a drip with aminocaproic acid and, instantly, the bleeding stopped. Also my normal blood pressure dropped in half, but fluids quickly returned it to normal and I left the hospital. Prognosis is it will certainly keep revisiting.
My husband has been dealing with RC for 2 years. It's been deja vu all over again; use of Foley 24/7 with increasing size diameters to dilate the urethra (about 6-8 weeks of that), followed immediately with total incontinence. That's where he is now again. Kegels, kegels, Depends, sitting &/or lying down as much as possible (only time no leakage!). He moves around the apartment using a typist chair on rollers! He's 78 so I don't see likelihood of surgical solution (ileostomy?).
So while the study study is welcome, it's too little too late & focus seems more on the weight RC brings on the ER services!!!!
Over a period of some five year, for my husband the results of radiation cystitis included a numerous visits to ER with retention, quite a few cystoscopies, no success from hyperbaric treatment, a failed urodynamic evaluation for an AUS until finally the only option to always needed pull ups and using a number of pads at once... and even then not being dry... my husband did successfully have an operation for an ileal conduit in late 2020.
Prior to his operation, when hospitalised for yet another bout of ESBL (a UTI) his infection control specialist told him that if he didn't go ahead he'd never get on top of managing this infection.
Although a tick younger than your husband, he's not in great condition and has a number of underlying co-morbidities yet he coped extremely well with the operation itself. It has made a huge difference to his quality of life and also made the obvious differences to the normal ongoing problems that continued incontinence brings. No more night visits to the bathroom or unexpected accidents and regularly wet clothing. These days, if he's unwell and needs to stay in bed then by leaving on the night bag means he doesn't have to worry about getting up to go to the toilet. I think, in the long term too, the benefits will continue if he becomes in need of more care.
I change his bag every second day. Where we live all the supplies needed are free via Medicare. It takes me no more than say about 10 or 15 minutes if I don't fuss too much and is just such an easy solution to the constant worry incontinence causes for everyone...him, myself, other family members.
I know everyone is different and the problem varies from person to person but looking back for us it has been a very good solution to the problem. Just thought I'd share this positive episode in what has been a rather troubled journey in other ways.
Marnie, thank you very much for reminding me of your husband's journey & the solution that has worked. It might come to this for my hubs & so you give me much encouragement & hope. He sees the uro in a month or so -- topic to broach. A consideration for my man is that he likely is having a biochemical recurrence -- very low but rising PSA -- if it keeps going up (last time, actually went down a bit), oncologist says ADT (Casodex). As someone here noted, "radiation cystitis is the gift that keeps on giving"!!! And we want to throw it out!!!
I'm sorry that radiation cystitis has been such an ordeal for you. Dr. Myers, in a vlog post described radiation as a treatment that keeps on giving. When I had my salvage radiation, some years before you, the only thing I was warned of was a slight increase in colorectal cancer after 5 years.
My dad completed 20 SBRT sessions in beg of October. Towards the end he started having symptoms. Since than he has pain from contractions, urgency to urinate, some blood. He can bearly sit down due to pain so he spends most of the day standing - he even eats lunch standing! Not much support from doctors - we tipically hear he is still in early phase of recovery. It has had very negative impact on quality of life. He used to walk miles every day now he stays indoor all the time.
I just had a cystoscopy to clear my kidney. We expected tumor in the bladder, but the pathology says no, and calls it radiation-induced urothelial atypia.
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Can Lupron trigger gross hematuria with clots in those men with radiation cystitis? Anyone experience this?
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