Presentation Authors: Isamu Tachibana*, Zain A Abedali, Ronald Boris, Indianapolis, IN
Introduction: Treating radiation changes to the bladder can be difficult for intractable symptoms. Our aim was to investigate whether surgical intervention for severe radiation cystitis was efficacious by objectively quantifying improvement in quality of life.
Methods: We examined our IRB institutional database of 286 radiation cystitis patients from 2011 to 2017, and identified 45 patients who underwent definitive surgical management. Of these, 61% of patients underwent cystectomy during surgery. We identified quality of life measures that could be studied pre-operatively and post-operatively for comparison.
Results: Patients who developed severe radiation cystitis requiring definitive surgical management typically presented 10 years after completing radiation therapy. The patient characteristics, including radiation type, reason for radiation, and perioperative information are demonstrated in Table 1. Regarding urinary diversion, 89% of patients had ileal conduits, 9% of patients had continent urinary reservoirs, and one patient only had cystectomy with bilateral nephrostomy tubes for diversion. Intractable symptoms requiring definitive surgical management included incontinence (38%), refractory hematuria (22%), urinary tract strictures (20%), fistula (11%), pelvic pain (7%), and bladder cancer (2%). We continued to follow patients with a mean follow up time of 14.6 months. We found that these patients after surgery required fewer post-operative procedures, hospitalizations, and transfusions as seen in Figure 1.
Conclusions: The toxicity of radiation can be debilitating years after completing treatment. Our institutional findings suggest definitive surgical management for intractable symptoms can significantly improve quality of life measures.