Chemical‐ and radiation‐induced haemorrhagic cystitis: current treatments and challenges

<jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>To review the published data on predisposing risk factors for cancer treatment‐induced haemorrhagic cystitis (<jats:styled-content style="fixed-case">HC</jats:styled-content>) and the evidence for the different preventive and therapeutic measures that have been used in order to help clinicians optimally define and manage this potentially serious condition.</jats:p></jats:list-item> <jats:list-item><jats:p>Despite recognition that <jats:styled-content style="fixed-case">HC</jats:styled-content> can be a significant complication of cancer treatment, there is currently a lack of <jats:styled-content style="fixed-case">UK</jats:styled-content>‐led guidelines available on how it should optimally be defined and managed.</jats:p></jats:list-item> <jats:list-item><jats:p>A systematic literature review was undertaken to evaluate the evidence for preventative measures and treatment options in the management of cancer treatment‐induced <jats:styled-content style="fixed-case">HC</jats:styled-content>.</jats:p></jats:list-item> <jats:list-item><jats:p>There is a wide range of reported incidence due to several factors including variability in study design and quality, the type of causal agent, the grading of bleeding, and discrepancies in definition criteria.</jats:p></jats:list-item> <jats:list-item><jats:p>The most frequently reported causal factors are radiotherapy to the pelvic area, where <jats:styled-content style="fixed-case">HC</jats:styled-content> has been reported in up to 20% of patients, and treatment with cyclophosphamide and bacillus <jats:styled-content style="fixed-case">C</jats:styled-content>almette‐<jats:styled-content style="fixed-case">G</jats:styled-content>uérin, where the incidence has been reported as up to 30%.</jats:p></jats:list-item> <jats:list-item><jats:p>Mesna (2‐mercaptoethane sodium sulphonate), hyperhydration and bladder irrigation have been the most frequently used prophylactic measures to prevent treatment‐related cystitis, but are not always effective.</jats:p></jats:list-item> <jats:list-item><jats:p>Cranberry juice is widely cited as a preventative measure and sodium pentosanpolysulphate as a treatment, although the evidence for both is very limited.</jats:p></jats:list-item> <jats:list-item><jats:p>The best evidence exists for intravesical hyaluronic acid as an effective preventative and active treatment, and for hyperbaric oxygen as an equally effective treatment option.</jats:p></jats:list-item> <jats:list-item><jats:p>The lack of robust data and variability in treatment strategies used highlights the need for further research, as well as best practice guidance and consensus on the management of <jats:styled-content style="fixed-case">HC</jats:styled-content>.</jats:p></jats:list-item> </jats:list></jats:p>