Résumé
La radiothérapie pelvienne détermine une fibrose chronique et une endartérite progressive de la sous-muqueuse et des muscles vésicaux peu oxygénés, associées à des lésions cicatricielles. Ces lésions peuvent conduire à une cystite hémorragique. Les délais d’apparition de la cystite radique sont de six mois à dix ans après l’irradiation pelvienne. Une hématurie modérée à sévère est rapportée dans 3 à 5 % des cas après radiothérapie. Le traitement de première ligne repose sur les irrigations vésicales. L’acide aminocaproïque, les estrogènes, le pentosanpolysulfate de sodium ont été essayés avec un succès relatif. Les traitements intravésicaux par nitrate d’argent, prostaglandines ou formaline sont parfois utilisés en cas de persistance des saignements. L’embolisation sélective des artères hypogastriques, la dérivation urinaire sont réservées aux cas sévères. Plus récemment, l’oxygénothérapie hyperbare a été proposée.
Abstract
Pelvic radiotherapy causes chronic fibrosis and progressive endarteritis in poorly oxygenated bladder submucosal and muscular tissues, with eventual tissue scarring. This can potentially lead to bladder mucosal sloughing and symptomatic hemorrhagic cystitis. Delayed radiation-induced hemorrhagic cystitis can occur six months to ten years after pelvic irradiation. Numerous studies have reported the incidence of moderate to severe hematuria in a range of 3% to 5% after radiotherapy. The primary treatment modality for hemorrhagic cystitis is bladder irrigation. Oral and intravenous agents such as aminocaproic acid, estrogens, and sodium pentosan polysulfate have been tried with limited success. Intravesical treatments with alum silver nitrate, prostaglandins, or formalin are sometimes used when bleeding persists. Finally, selective embolization of the hypogastric arteries, urinary diversion, and cystectomy may be performed as necessary in the most severe cases. Recently, hyperbaric oxygen has emerged as a potential primary option for the management of this challenging condition.
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Rigaud, J., Le Normand, L. & Labat, J.J. Cystite radique. Pelv Perineol 5, 116–120 (2010). https://doi.org/10.1007/s11608-010-0302-5
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DOI: https://doi.org/10.1007/s11608-010-0302-5