Published: 2019-05-24

Management of late hemorrhagic radiation cystitis in patients of carcinoma cervix with special reference to 1% alum irrigation and its safety: a clinical study in a tertiary care centre

Sasanka Kumar Barua, Nabajeet Das, S. J. Baruah, Rajeev T. P., Puskal Kumar Bagchi, Debanga Sarma, Mandeep Phukan


Background: Radiation cystitis is a well-known complication arising from radiation therapy in pelvic malignancies. Haematuria is usually the main presenting symptom of radiation cystitis, which can range from mild to severe refractory and life-threatening forms. There are various forms of treatment ranging from intravesical instillations like alum, formalin, prostaglandins and pentosan sulphate; hyperbaric oxygen therapy to surgical treatment like cystoscopic fulguration, arterial ligation and cystectomy.

Here authors aimed to find the efficacy of 1% alum irrigation in controlling haematuria due to radiation cystitis and to correlate its use with change in clinical status and biochemical parameters.

Methods: This   retrospective study was done for a period from July 2010 to July 2017 which included all female cervical cancer patients with intractable haematuria due to radiation cystitis. Only patients with normal renal function were included. Irrigation with 0.9% NS, hem coagulase and subsequently 1% alum irrigation were given. Failed cases underwent cystoscopic fulguration.

Results: Average age of presentation was 59.79 years. Of the 34 patients 20 (64.51%) patients showed complete response, 4 (12.9%) patients showed partial response and 7 (22.58%) patients had no response to alum irrigation and cystoscopic fulguration were done in these cases. There was no significant change in vital parameters and biochemical parameters except increased prothrombin time (<0.001).

Conclusions: No standard of care therapy is presently available for patients with hematuria following radiation cystitis although there is big armamentarium of therapies. Authors found that 1% alum irrigation is safe and efficacious for these patients although normal renal function is a prerequisite.


Cervical cancer, Hematuria, 1% alum irrigation, Radiation cystitis

Full Text:



Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA: a cancer. J Clinic. 2011;61(2):69-0.

Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. New Eng J Med. 1999;340(15):1144-53.

Russell NS, Bartelink H. Radiotherapy: the last 25 years. Canc Treat Reviews. 1999;25(6):365-76.

Smit SG, Heyns CF. Management of radiation cystitis. Nature Reviews Urol. 2010;7(4):206.

Liem X, Saad F, Delouya G. A practical approach to the management of radiation-induced hemorrhagic cystitis. Drugs. 2015;75(13):1471-82.

Radiation therapy oncology group. RTOG/EORTC late radiation morbidity scoring schema, 1999. Available at: http://www.rtog. org/members/toxicity/late.html.

Arrizabalaga M, Extramina J, Parra JL, Ramos C, Gonzalez RD, Leiva O. Treatment of massive haematuria with aluminous salts. Brit J Urol. 1987;60(3):223-6.

Goswami AK, Mahajan RK, Nath R, Sharma SK. How safe is 1% alum irrigation in controlling intractable vesical hemorrhage?. J Urol. 1993;149(2):264-7.

Phelps KR, Naylor K, Brien TP, Wilbur H, Haqqie SS. Encephalopathy after bladder irrigation with alum: case report and literature review. Am J Med Sci. 1999;318(3):181-5.

Miura M, Sasagawa I, Kubota Y, Iijima Y, Sawamura T, Nakada T. Effective hyperbaric oxygenation with prostaglandin E 1 for radiation cystitis and colitis after pelvic radiotherapy. Int Urol Nephrol. 1996;28(5):643-7.

Lowe BA, Stamey TA. Endoscopic topical placement of formalin soaked pledgets to control localized hemorrhage due to radiation cystitis. J Urol. 1997;158(2):528-9.

Mićić S, Genbačev O. Post-irradiation cystitis improved by instillation of early placental extract in saline. European Urol. 1988;14:291-3.

Sandhu SS, Goldstraw M, Woodhouse CR. The management of haemorrhagic cystitis with sodium pentosan polysulphate. BJU Int. 2004;94(6):845-7.

Liu YK, Harty JI, Steinbock GS, Holt HA, Goldstein DH, Amin M. Treatment of radiation or cyclophosphamide induced hemorrhagic cystitis using conjugated estrogen. J Urol. 1990;144(1):41-3.

Veerasarn V, Khorprasert C, Lorvidhaya V, Sangruchi S, Tantivatana T, Narkwong L, et al. Reduced recurrence of late hemorrhagic radiation cystitis by WF10 therapy in cervical cancer patients: a multicenter, randomized, two-arm, open-label trial. Radiotherapy Oncol. 2004;73(2):179-85.

Chuang YC, Kim DK, Chiang PH, Chancellor MB. Bladder botulinum toxin A injection can benefit patients with radiation and chemical cystitis. BJU Int. 2008;102(6):704-6.

Wines MP, Lynch WD. A new minimally invasive technique for treating radiation cystitis: the argon‐beam coagulator. BJU Int. 2006;98(3):610-2.

Safra T, Gutman G, Fishlev G, Soyfer V, Gall N, Lessing JB, et al. Improved quality of life with hyperbaric oxygen therapy in patients with persistent pelvic radiation-induced toxicity. Clinic Oncol. 2008;20(4):284-7.

Rodríguez-Patrón RR, Sanz EM, Gómez IG, Blazquez JS, Sanchez JC, Briones GM, et al. Hypogastric artery embolization as a palliative treatment for bleeding secondary to intractable bladder or prostate disease. Spanish Urol Archi. 2003;56(2):111-8.

De Berardinis E, Vicini P, Salvatori F, Sciarra A, Gentile V, Di Silverio F. Superselective embolization of bladder arteries in the treatment of intractable bladder haemorrhage. Int J Urol. 2005;12(5):503-5.

Ravi R, Dewan AK, Pandey KK. Transverse colon conduit urinary diversion in patients treated with very high dose pelvic irradiation. Brit J Urol. 1994;73(1):51-4.

Goel AK, Rao MS, Bhagwat AG, Vaidyanathan S, Goswami AK, Sen TK. Intravesical irrigation with alum for the control of massive bladder hemorrhage. J Urol. 1985;133(6):956-7.

Ostroff EB, Chenault OW. Alum irrigation for the control of massive bladder hemorrhage. J Urol. 1982;128(5):929-30.

Parmar B, Mansuri S, Garg K, Solanki D. Efficacy of haemocoagulase a topical hemostatic agent after 3rd molar surgery. J Maxillofac Oral Surg. 2006;5:5-9.

Shi Y, Zhao J, Tang S, Pan F, Liu L, Tian Z, et al. Effect of hemocoagulase for prevention of pulmonary hemorrhage in critical newborns on mechanical ventilation: a randomized controlled trial. Indian Pediatr. 2008;45(3):199.

Kennedy C, Snell ME, Witherow R. Use of alum to control intractable vesical haemorrhage. Brit J Urol. 1984;56:673.

Kavoussi LR, Gelstein LD, Andriole GL. Encephalopathy and an elevated serum aluminium level in a patient receiving intravesical alum irrigation for severe urinary hemorrhage. J Urol. 1986;136(3):665-7.

Waldron-Edward D, Chan P, Skoryna SC. Increased prothrombin time and metabolic changes with high serum aluminium levels following long-term exposure to Bayer-process alumina. Canadian Med Assoc J. 1971;105(12):1297.

Levenback C, Eifel PJ, Burke TW, Morris M, Gershenson DM. Hemorrhagic cystitis following radiotherapy for stage IB cancer of the cervix. Gynecol Oncol. 1994 55(2):206-10.

Wines MP, Lynch WD. A new minimally invasive technique for treating radiation cystitis: the argon- beam coagulator. BJU Int. 2006:98:610-2.