The number of patients diagnosed with pelvic malignancy in the UK is approximately 82,500 per year. Of these approximately 12,000 undergo pelvic radiotherapy annually to treat cancers of the prostate, bladder, rectum and gynaecologic organs. Although radiotherapy allows for direct targeting of high-energy radiation to the tumour site, exposure to the bladder even when the bladder is not the target organ is unavoidable and may cause radiation cystitis.
Radiation cystitisis a debilitating condition and consists of three distinct phases:
- an acute phase which starts during treatment and resolves within several weeks after the end of RT
- a symptom-free dose-dependent phase which can last months to years
- a chronic irreversible late-response phase.
Symptoms can present as early as 2 months or as late as 15 years after the radiation dose and include:
- urinary frequency and urgency
- urinary incontinence
- pelvic, bladder or urethral pain
- haematuria (blood in the urine) either non-visible (urine dipstick tested) or visible haematuria with blood clots
These symptoms can be difficult to treat and may lead to multiple hospital admissions with the need for blood transfusions and invasive surgical treatment in severe cases.
In order to improve management of radiation cystitis and the quality of life of patients with this condition, since January 2017, at Guy’s and St Thomas’ Hospital, we have started a specialist radiation cystitis clinic (Code:77L).
This service is led by Mr Ramesh Thurairaja, a consultant urological surgeon based at Guy’s Hospital. We see any previously treated pelvic radiotherapy patients with different bladder symptoms and management is undertaken in a multi-disciplinary fashion involving urology, chronic pain, interventional radiology and psychology teams.