Radiation Induced Cystitis and Proctitis - Prediction, Assessment and Management

Cystitis and proctitis are defined as inflammation of bladder and rectum respectively. Haemorrhagic cystitisis the most severe clinical manifestation of radiation and chemical cystitis. Radiation proctitis and cystitis aremajor complications following radiotherapy. Prevention of radiation-induced haemorrhagic cystitis has beeninvestigated using various oral agents with minimal benefit. Bladder irrigation remains the most frequentlyadopted modality followed by intra-vesical instillation of alum or formalin. In intractable cases, surgicalintervention is required in the form of diversion ureterostomy or cystectomy. Proctitis is more common in evenlow dose ranges but is self-limiting and improves on treatment interruption. However, treatment of radiationproctitis is broadly non-invasive or invasive. Non-invasive treatment consists of non-steroid anti-inflammatorydrugs (NSAIDs), anti-oxidants, sucralfate, short chain fatty acids and hyperbaric oxygen. Invasive treatmentconsists of ablative procedures like formalin application, endoscopic YAG laser coagulation or argon plasmacoagulation and surgery as a last resort.