Presentation Authors: Ismaël Chelghaf*, Quentin Alimi, Karim Bensalah, Peyronnet Benoit, Nantes, France
Introduction: Radiation-induced hemorrhagic cystitis is the most frequent sequelae of pelvic radiotherapy. Its induce frequent hospitalizations, surgical interventions, and blood transfusions.Multiple treatments have been tried, but the management of this damages is difficult and ill-defined.The aim of the study was to compare efficacy and safety of coagulation for telangiectasias and hemorrhagic cystitis, with Greenlight XPS laser, Holmium laser, and monopolar electrocoagulation.
Methods: Between 2007 and 2018, all patients with pelvic irradiation history and elective or emergency surgery for hemorrhagic cystitis, have been retrospectively included. Holmium laser was mainly used between 2007 and 2011, then monopolar coagulation between 2011 and 2014 ; finally the GreenLight XPS laser, with Extended Application fiber (EA) from 2015. Perioperative and long-term results has been compared for the 3 techniques.
Results: 59 procedures, for 44 patients, have been included. 18 procedures were realized by GreenLight XPS laser, 16 by monopolar coagulation, and 25 by Holmium laser, with higher major toxicity rate for monopolar group (RTOC/EORTC grade>2 : 0% vs 37,5% vs 12% : p=0.008). Clavien-Dindoâ‰¥3 intraoperative and post-operative complications rate, was statistically higher in monopolar group (p=0.01 and p=0,0006, table), like length of hospital stay (p=0.02). Median follow-up was 13, 38, and 58 months (p < 0.0001), and hematuria recurrence rate was higher in Holmium laser group (39% vs 50% vs 80% ; p=0.02). However survived without treatment (surgery or hyperbaric oxygen) were comparable between the 3 groups (p=0.56).
Conclusions: For patient suffering from hematuria, caused by radiation-induced cystitis, efficacy of coagulation by GreenLight XPS laser seemed higher than monopolar or Holmium laser.These results must be confirmed by long-term data and more cases.