Management of End-Stage Radiation Cystitis in the Cancer Survivor

Millions of cancer survivors have received pelvic radiation, and a significant minority of them will have long-term lower urinary tract sequelae manifesting as hematuria, storage and emptying dysfunction, and fistulas. Hemorrhagic radiation cystitis is managed with intravesical agents in the acute setting, and systemic oral and hyperbaric oxygen therapy for long-term control. In certain cases, however, urinary diversion will be required. Similarly, most cases of lower urinary tract symptoms relating to poor storage and emptying can be managed conservatively. However, some will warrant urinary diversion. Radiation-related urinary fistulas have notoriously poor outcomes after attempts at repair, and early consideration to urinary diversion should be given in these cases. Continent as well as incontinent urinary diversion can be safely performed in patients with prior pelvic radiation, and limited contemporary data confirm significant quality-of-life improvements after urinary diversion in patients with end-stage radiation cystitis.