ENDOSCOPIC INTRAVESICAL FIBRIN GLUE APPLICATION IN THE TREATMENT OF REFRACTORY HEMORRHAGIC RADIATION CYSTITIS: A SINGLE COHORT PILOT STUDY.

Objective To evaluate the clinical value of endoscopic fibrin glue (FG) application therapy in treating hemorrhagic radiation cystitis (HRC). Patients and Methods This is a single cohort, prospective pilot study. We collected data from patients with HRC who were treated at our urology unit during the period May 2014 to December 2016. Patients with grade >=2 HRC for whom conventional therapy and trans-urethral 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 the FG intervention, patients' clinical status was defined as either: (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. Results A total of 20 patients (12 women and 8 men, with a mean age of 69 +/- 7.5 years) were treated with 12 mL of 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 6 patients (30%). Conclusion Application of FG is an effective, practical, affordable and repeatable procedure for the treatment of grade >=2 HRC.