Hyaluronic Acid Helps in Radiation-Induced Hemorrhagic Cystitis
By David Douglas
NEW YORK (Reuters Health) Oct 14 – Instillation of hyaluronic acid (HA) into the bladder decreases bleeding, pain, and voiding in patients with radiation-induced hemorrhagic cystitis, Chinese researchers report.
The relief in their small cohort of 36 patients lasted for at least a year.
"In our preliminary experience, intravesical instillation of HA may be a good alternative to hyperbaric oxygen," Dr. Zhou-jun Shen told Reuters Health by email. Moreover "HA therapy is safe and easy to perform."
Dr. Shen and colleagues at Shanghai Jiaotong University say hemorrhagic cystitis is relatively rare. In patients with pelvic cancers, however, "it is a relatively common and potentially severe complication of high-dose chemoradiotherapy," according to their paper online September 2 in BJU International.
The incidence of hemorrhagic cystitis has risen in concert with the use of radiation.
HBO has been extensively and successfully used to treat this condition, but at great cost, and it is often unavailable in Chinese hospitals.
Patients in the current study were randomly assigned to treatment with either HA or HBO. HA was instilled weekly in the first month and then monthly for another two months. The HBO group was treated with 100% oxygen in a hyperbaric chamber once a day, seven days a week, for at least a month.
The main side effect of HA instillation was urinary tract infection due to repeated urethral catheterization. This trended higher in the first six months but there were no significant between-group differences at 12 and 18 months.
Both groups had similar improvements in hematuria, frequency of voiding, and visual analogue scale pelvic pain scores at six to 18 months after treatment. The decrease in voiding frequency was significant in both groups six months after treatment, but it was only significant in the HA group at 12 months after therapy.
"Despite its slightly higher incidence of urinary tract infection, intravesical instillation of HA is cheaper and much more convenient than HBO treatment," the authors conclude.