PD32-12: Radical cystectomy for the treatment of pelvic radiation cystitis: a single high-experience center study

Alberto Piana*, Jordi Huguet, Antoni Sanchez-Puy, Angelo Territo, Pietro Diana, Andrea Gallioli, Francesco Sanguedolce, Alejandra Bravo, Antonio Rosales, Ruben Parada, Joan Palou, Alberto Breda, Barcelona, Spain

Introduction: Radiation therapy (RT) for the treatment of pelvic oncological diseases is burdened by high rates of complications. When the radiation cystitis (RC) represents a life-threatening condition or when it significantly affects the patient’s quality of life due to hematuria and irritative voiding syndrome, a subsequent cystectomy is usually considered to improve patient’s clinical conditions. In this study, we reported perioperative and long-term post-operative outcomes of patients underwent cystectomy for radiation cystitis.

Methods: In this retrospective analysis carried out from our institutional perspective database, we enrolled patients who underwent cystectomy for radiation cystitis in our center from 2008 to 2020. We collected demographic, perioperative and follow up data. Finally, the results were compared with those of standard radical cystectomies available in the literature.

Results: 38 patients were enrolled in this study, 31 (81.6%) were males and 7 (18.4%) females with a median (IQR) age of 74.5 years (68.7-79.5). Median follow-up was 28 months (4.75-66.5). Most of the RTs were performed as salvage (16, 42.1%) and primary treatment (10, 26.3%) for prostate cancer. 

Treatments for radiation cystitis prior to the cystectomy were: endoscopic electrocoagulation in 28 patients (73.6%), hyperbaric chamber in 2 (5.26%), hyaluronic acid intravesical instillation in 2, formalin intravesical instillation in 2 and urethrotomy in 3 (7.89%). The median time between radiotherapy and cystectomy was 108 months (60-144). All cystectomies were performed with an open approach. In 4 (10.53%) patients it was not possible to remove the entire prostate. The median operative time and bleeding were 300 minutes (300-360) and 600ml (425-1000). 35 (92.1%) ileal conduits and 3 (7.89%) skin ureterostomies were performed. At 90 days 12 (31.58%) Clavien Dindo 2 and 9 (23.68%) ³ 2 complications occurred. 1 (2.63%) patient died from complications of surgery and 9 (23.68%) from other causes.

Conclusions: Cystectomy represents in many cases a mandatory treatment for RC non-responder to conservative treatments. However, the high side effect and complication rate of this treatment must be considered and explained to the patients prior to the definitive surgical indication.

Source of Funding: None