Symptoms of radiation cystitis

The bladder is the main place where urine accumulates. If there is a problem with the bladder, it means that the patient's urination function will have problems. You must know that urination function is very important for a person. Once frequent urination, urgency, incontinence or combined urinary tract infection occurs, you should consider that it may be a bladder problem. Although cystitis is more common, radiation cystitis is different from ordinary bladder, and principles must be followed in treatment.

During radiotherapy for pelvic tumors and cervical cancer, the bladder is one of the organs that is inevitably irradiated. Although the radiosensitivity of the bladder mucosa is lower than that of the intestinal mucosa, radiation cystitis is still inevitable after high-dose irradiation, with an incidence rate of 2.48% to 5.6%. The occurrence of radiation cystitis is related to the total radiation dose, radiotherapy technique and individual differences in radiosensitivity. The advancement of radiotherapy technology does not change the anatomical relationship between the lesions and the bladder and rectum during the treatment of uterine cancer; if the lesions are irradiated sufficiently, they will definitely affect the adjacent organs.

Introduction

It is generally believed that the bladder is less radiosensitive than the rectum, and ulcers are more likely to occur after irradiation of more than 60 Gy. Radiation cystitis is mainly caused by radiation-induced vascular damage, small blood vessel occlusion, mucosal congestion and edema leading to ulcers with obvious edema around them, and is often accompanied by infection and bleeding. After the ulcer heals, a white scar will remain, around which a reticular vascular dilation can be seen. Rupture of the blood vessels causes repeated bleeding, and hematuria may even occur more than 10 years after radiotherapy. Because the small vessel lesions (arterial occlusion, vascular wall fibrosis and sclerosis) caused by radiation progress slowly, the tissues are in a state of ischemia, resulting in atrophy and fibrosis of the mucosa, submucosal tissue, and muscles, leading to chronic bladder atrophy and reduced capacity (often only about 50ml), which can cause frequent urination, urinary incontinence, and are prone to infection.

symptom

(1) Mild: Only mild symptoms and signs, such as urinary urgency, urinary frequency, and urinary pain. Cystoscopy showed mucosal turbidity, congestion, and edema. (2) Moderate: In addition to the above symptoms, there is also bladder mucosal capillary dilation hematuria, which may recur. Cystoscopy may reveal mucosal edema, a considerable area of ​​dilation of the fibrous membrane and capillaries, which may be accompanied by ulcers. The lesions are often located in the folds between the posterior wall of the bladder trigone and the ureters. (3) Severe: vesicovaginal fistula formation.

diagnosis

1. History of radiation therapy to the bladder area or vagina. 2. It may be painless hematuria, mild urinary frequency, or urinary pain and difficulty. Severe hematuria can cause anemia. 3. Urinalysis shows a high number of red blood cells. Tumor cells were negative. 4. Cystoscopy: Extensive bleeding spots or patchy hemorrhages and dilated small blood vessels were found on the mucosa, and there were ulcers and inflammatory granulation tissue near the triangle area. If necessary, a biopsy should be performed to differentiate it from the tumor.

treat

For mild and moderate acute radiation cystitis, conservative treatment is mainly used, such as antibiotics for anti-inflammatory, hemostasis and symptomatic treatment to relieve bladder irritation symptoms. Drugs can be used systemically in a manner similar to that used for general cystitis. Commonly used topical treatments include:

(1) Drug bladder irrigation. Benzocaine 0.3g, belladonna tincture 0.5g, gentamicin 120,000U, dexamethasone 1.5mg, add normal saline to 30ml, and instill into the bladder twice a day.

(2) Inject 50 ml of 2% benzocaine through the catheter, retain it for 5 minutes and then release it. Inject 150-200 ml of 4% formaldehyde solution (the amount can be adjusted according to the bladder capacity) and retain it for 1 minute before releasing it. Then inject 200 ml of 50% alcohol and rinse twice. This method is mainly used to treat hemorrhagic cystitis.

(3) Bladder instillation of alum solution. Alum solution is an astringent that is not absorbed by the body. It can precipitate proteins on the bleeding surface, reduce cell membrane permeability, and harden the adhesive substance of capillary endothelial cells, thereby slowing down the flow of plasma proteins in the capillaries, reducing local tissue edema, inflammation and exudation and stopping bleeding. Before use, flush the bladder with normal saline through a three-chamber Foley catheter to drain as much blood clot as possible, then infuse the bladder with 250 ml of 1% alum solution and leave it for 20 minutes to drain. The same method can be repeated 3 times.