1 Urology Unit, San Carlo di Nancy General Hospital, Rome, Italy.
2 Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy.
J Endourol. 2019 Feb;33(2):93-98. doi: 10.1089/end.2018.0028.
To evaluate the clinical value of endoscopic fibrin glue (FG) application therapy in treating hemorrhagic radiation cystitis (HRC).
This is a single-cohort, prospective pilot study. We collected data from patients with HRC who were treated at our urology unit from May 2014 to December 2016. Patients with grade ≥2 HRC for whom conventional therapy and transurethral endoscopic electrocoagulation had failed were treated with endoscopic intravesical FG. The mean follow-up was 26.2 ± 9.78 months. Our analysis included data on patient demographics, pelvic malignancies, radiotherapy regimens, total dose of radiation received, time of onset and severity of hematuria, and previous intravesical management. Following FG intervention, patients' clinical status was defined as: (1) clinical response; absence of dysuria, urgency, and frequency; discontinuation of analgesic medication; and Foley catheter removal, but with ongoing hematuria grade <2; (2) complete response, clinical response, and no further hematuria; or (3) no response, no clinical response, and sustained hematuria.
A total of 20 patients (12 women and 8 men; mean age, 69 ± 7.5 years) were treated with 12 mL FG intravesically, using endoscopic application. Of the 20 patients, 16 (80%) had a complete response and 4 (20%) had a clinical response. In the case of four patients (20%), treatment was carried out twice. Mean hospital stay was 6 ± 2.5 days. The intervention showed good tolerability in all patients. No major adverse events were reported. Bladder spasms were the only minor adverse events reported in six patients (30%).
Application of FG is an effective, practical, affordable, and repeatable procedure for the treatment of grade ≥2 HRC.
评估内镜纤维蛋白胶（FG）应用疗法治疗放射性出血性膀胱炎（HRC）的临床价值。
这是一项单队列、前瞻性初步研究。我们收集了 2014 年 5 月至 2016 年 12 月在我院泌尿科治疗的 HRC 患者的数据。对常规治疗和经尿道内镜电凝治疗失败的≥2 级 HRC 患者，采用内镜膀胱内 FG 治疗。平均随访时间为 26.2±9.78 个月。我们的分析包括患者人口统计学资料、骨盆恶性肿瘤、放疗方案、接受的总辐射剂量、血尿的发病时间和严重程度以及先前的膀胱内管理。FG 干预后，患者的临床状况定义为：（1）临床反应：无尿痛、尿急和尿频；停用止痛药；拔除 Foley 导管，但仍有血尿程度<2；（2）完全反应，临床反应，且无进一步血尿；或（3）无反应，无临床反应，且持续血尿。
共 20 例患者（12 例女性，8 例男性；平均年龄 69±7.5 岁）接受了 12mL 内镜下 FG 膀胱内应用治疗。20 例患者中，16 例（80%）完全缓解，4 例（20%）临床缓解。4 例患者（20%）接受了两次治疗。平均住院时间为 6±2.5 天。所有患者均耐受良好，无重大不良事件发生。有 6 例患者（30%）报告出现膀胱痉挛等轻微不良反应。
FG 应用是治疗≥2 级 HRC 的一种有效、实用、经济且可重复的方法。
