Treatment of late radiation injuries to the bladder

Instillations of the bladder and urethra have been widely used for decades in cases where it is necessary to carry out effective and rapid treatment of the bladder. Initially, this method was used only in men since the 19th century, but when such treatment of prostatitis and other diseases of an inflammatory nature in men showed good results, the bladder instillation technique was improved and optimized, including for women.

Today, bladder instillations have found widespread use in the treatment of diseases of the urethra, prostate (prostate gland) and seminal tubercle in men, the bladder, as well as in chemotherapy practice for oncology of the urinary system.

Perhaps the main and very significant advantage of this method of treatment over the oral (by mouth) use of drugs is its local administration. By acting directly on the source of inflammation, the administered drug almost instantly causes the development of the desired effects, without involving the entire body in the process of fighting the infection.

Other benefits of bladder instillation:

• absence of side effects from organs and systems due to local effects on the inflammatory focus;
• the possibility of truly strict control over the concentration of the substance due to its route of administration directly to the desired location;
• maximum concentration of the active substance locally, at the site of inflammation;
• achieving the effect as quickly as possible.

What is bladder installation?

During the procedure, medication is injected into the bladder through the urinary tract. An installer is used for administration, and the manipulation itself is preceded by a series of laboratory tests, the main of which are cystoscopy and biopsy.

Medicines used:

• antiseptics;
• antibiotics;
• ozonated solutions.

The advantage of such treatment is that the drugs act locally, which means it is permissible to use a higher concentration of the drug, and the active substance remains inside the bladder for a long time, providing the therapeutic effect as fully as possible.

Restrictions on the procedure

Instillation of the bladder can be quite a dangerous event if the patient has certain conditions:

• exacerbation of infectious diseases of the pelvic organs;
• urethral traumatic lesions;
• any disease in the acute phase;
• allergies to medications.

Note: a test to determine the tolerance of prescribed honey is required. drugs, since the body’s reaction can be acute and intense.

No negative effects on other organs and life support systems were detected during the practical application of the procedure.

Performing bladder instillation

As you know, treatment of the bladder, including treatment of cystitis, treatment of prostatitis and some other inflammatory diseases, often requires taking antibacterial, anti-inflammatory and other groups of drugs, plus mandatory herbal medicine with the addition of herbs and berries. Sometimes this treatment is not as effective as we would like, and then bladder instillations come to the rescue.

When carrying out instillation of the bladder, various medications can be used, including a 3% solution of boric acid, sublimate, rivanol, 1% methylene blue, collargol and many others. Oils, antiseptic or antibacterial solutions, combination drugs that are not aggressive to mucous membranes and quickly produce a therapeutic effect - all of them are widely used in medical practice.

Due to the widespread use of manipulation, for the convenience of patients and doctors, special syringes with the required concentration of the drug have been created. Before the procedure, the patient empties the bladder, and after administration of the drug it is recommended to refrain from visiting the toilet for an hour.

When instilling the urethra, it is sufficient to administer 10 milliliters of the drug. Bladder instillations require correspondingly large volumes, but not more than 100 milliliters.

The sequence of the procedure can be represented as follows:

1. hygienic treatment of the urethral area using an antiseptic;
2. installation of a urinary catheter (in the case of the urethra, you can use a special syringe);
3. injection of the drug into the urethra (urethra) and bladder.

Bladder instillation in men

In men, the procedure is most often performed in cases of cancer and bacterial inflammation of the genitourinary system (cystitis and other bladder infections). To be prescribed, the disease must occur in a certain form - infectious foci must be surrounded by a specific membrane (encystation).

To prevent relapses, it is necessary to complete a full course of drug administration through a catheter, without stopping manipulations when improvement occurs. For cancer pathologies, this therapy is the most optimal option to minimize the effect of aggressive drugs on other internal organs, especially the liver.

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Carrying out the procedure in women and children

In women, bladder instillation is most often practiced for cystitis in a chronic form that cannot be treated with other methods. This makes it possible to reduce the number of general antibiotic prescriptions, since bacteriophages that are harmful to viruses are injected directly into the bladder. In addition, silver-based products and mucosal healing extracts are effective in this case.

In case of cystitis in the acute stage in women, manipulations with the catheter are not performed. If a course of antibiotics is necessary, it is carried out in parallel with special guide drugs for maximum anti-inflammatory effect.

Instillation of the bladder in children is possible in the presence of chronic urological problems (cystitis, etc.). This helps reduce healing time, reduce the toxic effects of drugs and increase the effectiveness of therapy.

Treatment of late radiation injuries to the bladder

The article analyzes the results of treatment of patients with late radiation injuries of the bladder (complicated and uncomplicated cystitis). It is noted that the choice of treatment method should be based on data from subjective complaints and objective research methods. Thus, with severe pain syndrome and encrusted form of radiation cystitis, the best results were observed with intravesical use of Dimexide. In case of a pronounced inflammatory process, accompanied by a superficial disorder of the bladder mucosa, as well as atrophy of the mucosa, preference should be given to instillations of URO-HYALA. Rexod has demonstrated effectiveness in patients with hemorrhagic syndrome, ulcerative radiation cystitis and reduced bladder volume.

Table 1. Comparative characteristics of the results of treatment of patients of the first group before and after intravesical use of Dimexide

Table 2. Comparative characteristics of cystoscopic signs of radiation cystitis in patients of the first group before and after intravesical use of Dimexide

Table 3. Comparative characteristics of patients in the second group before and after intravesical use of URO-GYAL

Table 4. Comparative characteristics of cystoscopic signs of radiation cystitis in patients of the second group before and after intravesical use of URO-HYAL

Table 5. Comparative characteristics of patients in the third group before and after intravesical use of Rexod

Table 6. Comparative characteristics of cystoscopic signs of radiation cystitis in patients of the third group before and after intravesical use of Rexod

Introduction

Currently, radiation therapy is one of the main methods of treating malignant neoplasms of the pelvic organs. In the absence of metastases to regional lymph nodes, the use of radiation therapy allows for complete or partial regression of the tumor (cancer of the body and cervix, prostate cancer, and, to a lesser extent, cancer of the bladder and rectum) in an average of 70–75% of cases. At the same time, life expectancy after completing a course of treatment remains relatively high and amounts to about four to five years [1–3].

Unfortunately, some of these patients (10–15%) develop radiation damage to the pelvic organs: bladder, rectum and intrapelvic tissue [4, 5]. Assessing the literature data, we can state unsatisfactory results of diagnosis and treatment of radiation injuries of the pelvic organs. This is expressed in frequent relapses of cystitis resulting in shrinkage of the bladder, intrapelvic radiation fibrosis with compression of the intramural and juxtavesical parts of the ureters and the development of chronic renal failure [7–8].

Radiation therapy can be complicated by the development of radiation-induced fibrosis, the severity of which is directly proportional to the total absorbed dose, the fractionation regimen and the time after radiation therapy. Microscopic examination of tissues with radiation-induced fibrosis showed that its formation is accompanied by the development of a framework in the submucosal layer of the bladder wall, in the networks of which the walls of small arteries and veins are fixed. Radiation damage also occurs to the vascular wall itself, especially its adventitia, which leads to the loss of elasticity of the vessels and the appearance of fragility. Clinically, this is detected by varying degrees of hematuria, up to profuse bleeding. The subsequent development of radiation fibrosis of the entire bladder wall significantly aggravates the clinical symptoms and severity of radiation cystitis [9–11].

In the diagnosis of radiation cystitis, general clinical, radiological and instrumental research methods are important. The leading method for examining the bladder remains cystoscopy, which allows one to reliably establish the location and severity of radiation damage, that is, to identify organic changes in the mucous membrane, the presence of stones and visible tumor elements, and to assess the condition of the ureteric orifices.

Material and methods

In this work, we conducted a study of the effectiveness of new methods of local treatment of complicated and uncomplicated radiation cystitis. 139 patients were divided into three groups. The first group consisted of 49 patients (17 with uncomplicated cystitis and 32 with complicated ones). They received traditional local treatment: Dimexide, Collargol, synthetic emulsion and sea buckthorn oil. The second group included 52 patients (26 with uncomplicated cystitis and 26 with complicated ones), in whom the drug URO-HYAL was used for local treatment. In the local therapy of the third group - 38 patients (13 with uncomplicated cystitis and 25 with complicated ones) - superoxide dismutase (the drug Rexod) was used. In addition, all patients were prescribed antibacterial, anticoagulant, vasoactive, symptomatic and immune therapy.

Local treatment of patients in the first group began with instillations of 10% Dimexide in a volume of 20 ml. The use of this drug is pathogenetically justified, since it has a pronounced anti-inflammatory, anti-edematous and analgesic effect. Due to the fact that Dimexide is an organic solvent and easily penetrates tissue, antibiotics (gentamicin, amikacin), fibrolyzing (Lidase) and anti-inflammatory drugs (prednisolone) were added to the solution. Instillations were carried out daily at 20 ml (from 10 to 15 procedures). In patients with microhematuria or mild blood in the urine, 3% Collargol 20 ml per administration was additionally used for instillation of the bladder. If monotherapy with Collargol was ineffective, it was alternated with chilled aminocaproic acid to enhance the hemostatic effect. After the inflammatory processes subsided, synthetic emulsion and sea buckthorn oil were administered intravesically in a heated form once a day for 10–15 days. The action of these drugs is aimed at enhancing reparative processes in the wall of the bladder. Thanks to their fat base, they have a pronounced enveloping and analgesic effect.

Local treatment of patients in the second group involved the use of a drug based on hyaluronic acid URO-HYAL. URO-HYAL is a viscoelastic protector of the intercellular substance of the urothelium of the bladder and urethra. URO-HYAL allows you to create a viscoelastic film on the mucous membrane, thereby protecting it from the aggressive effects of urine and preventing the adhesion of microbes to the damaged surface. Instillations of URO-GYAL were carried out every other day for 12–15 days, then in the regime of one injection per week.

In the third group, patients were prescribed the superoxide dismutase drug Rexod. Rexod directly inactivates free radicals, blocks the reaction of peroxide radicals with arachidonic acid, weakens the active effect of leukotriene B4, inhibits the chemotaxis of leukocytes, significantly reduces collagen synthesis by fibroblasts (promotes regression of radiation-induced fibrosis). Rexod was injected into the bladder, and the contents of the bottle were dissolved immediately before administration in 10 ml of sterile saline. Instillations were carried out once a day for 15–20 days.

Results and discussion

The results of treatment of patients of the first group are presented in Table 1. The data presented indicate a significant decrease in the frequency of night urination and a decrease in bacteriuria in the majority of patients with both complicated and uncomplicated cystitis. Despite the still high level of leukocyturia, it was less pronounced. Gross hematuria after treatment was not detected in patients with uncomplicated cystitis, but persisted in 18% of patients with complicated cystitis.

A comparative analysis of ultrasound signs of radiation cystitis in patients of the first group demonstrated that intravesical use of Dimexide made it possible to clear the bladder of salt encrustation in more than 50% of cases. Unfortunately, the main ultrasound signs of inflammation (suspension in the lumen of the bladder and thickening of its walls) were eliminated in a small number of patients.

The dynamics of the severity of cystoscopic signs of radiation cystitis in patients of the first group before and after treatment are shown in Table 2. In patients with both uncomplicated and complicated cystitis, inflammation (hyperemia and edema) and telangiectasias persisted. Thus, intravesical use of Dimexide was most effective in patients with severe pain and an encrusted form of radiation cystitis.

The results of treatment of patients in the second group are presented in Table 3. It should be noted the pronounced anti-inflammatory effect of URO-GYAL. Thus, the frequency of nighttime urination was halved in more than 56% of patients with uncomplicated cystitis and in 59% with complicated cystitis. Leukocyturia decreased by half in patients with complicated cystitis and was practically not detected in patients with uncomplicated cystitis (12%), and bacteriuria remained only in 27 and 25% of patients in both subgroups, respectively.

The main ultrasound signs of inflammation (suspension in the lumen of the bladder and thickening of its walls) disappeared in the vast majority of patients. However, URO-HYAL had virtually no effect on encrusted cystitis, especially in patients with reduced bladder volume.

The characteristics of cystoscopic signs of radiation cystitis in patients of the second group before and after treatment are shown in Table 4. Hyperemia and edema bothered less than 25% of patients with both uncomplicated and complicated forms of cystitis. The incidence of erosion in patients with uncomplicated cystitis decreased fourfold. However, more than 70% of patients retained telangiectasias. Bladder ulcers in patients with complicated cystitis decreased in size and were cleared of fibrin.

It can be concluded that the treatment regimen used - instillation of URO-HYALA - is most effective in patients with severe inflammation and pain syndrome associated with inflammation of the bladder walls, and can be used in patients with any form of radiation cystitis complicated by a bacterial infection.

The results of treatment of patients in the third group are presented in Table 5. In almost half of the patients with uncomplicated and complicated cystitis, the frequency of night urination decreased by half. In 75 and 90% of patients, respectively, leukocyturia remained. However, bacteriuria was not detected in almost half of the patients in both subgroups, and gross hematuria disappeared in all patients.

Comparative characteristics of ultrasound signs of radiation cystitis in patients of the third group demonstrated a significant increase in bladder volume in patients with microcystis, but to a lesser extent Rexod had a positive effect on the encrustation of the bladder walls and the presence of suspension in its lumen.

As for the severity of cystoscopic signs of radiation cystitis in patients of the third group (Table 6), as a result of treatment, the bladder ulcer disappeared in all patients, however, in more than 60% of patients with complicated cystitis, signs of inflammation (hyperemia and edema) remained. Thus, Rexod can be recommended for patients with hemorrhagic syndrome, ulcerative radiation cystitis and reduced bladder volume.

Conclusion

It should be noted that the drugs used (Dimexide, URO-GIAL and Rexod) have different directions of action. In particular, with severe fibrosis of the bladder wall, preference should be given to the use of instillations of Dimexide solution. In case of a pronounced inflammatory process, accompanied by a superficial disorder of the bladder mucosa, as well as atrophy of the mucosa, the use of URO-HYAL turned out to be most effective. In patients with hematuria and deep violations of the integrity of the bladder mucosa (ulcerative-necrotizing cystitis), the use of superoxide dismutase demonstrated the best results. The choice of treatment method should be based on data from subjective complaints and objective research methods.

Stages of implementation

The procedure is carried out only by a specialist in a room equipped for this purpose using a special pharmaceutical device (catheter) or (in some cases) a disposable syringe. Instillation includes:

• emptying the bladder (if necessary, with the help of stimulants);
• treatment of the external part of the urethra with an antiseptic;
• catheter insertion;
• infusion of medication;
• removing the device;
• asepsis of the urinary opening.

A restriction on urination is set for three hours. Some pain of the manipulation is compensated by its short duration (about 10 minutes) and high efficiency.

To carry out the procedure, a consultation with a urologist is required. Make an appointment with a doctor and come to the Consultative and Diagnostic Center (formerly the “National Diagnostic Center”). Call the numbers listed on the website, or click the “SIGN UP” button.