Advancements in Understanding and Managing Radiation Cystitis: A Comprehensive Review.

PURPOSE OF REVIEW: This manuscript aims to provide a comprehensive overview of the pathophysiology, risk factors, prevention strategies, and management options for radiation cystitis. RECENT FINDINGS: Recent studies have shed light on the pathophysiology of radiation cystitis, highlighting the role of inflammation, fibrosis, and vascular damage. Emerging preventive measures like stem cell therapy offer promise, alongside novel treatments such as amniotic bladder therapy and hyperbaric oxygen therapy. This review outlines the latest research on radiation cystitis, covering its pathophysiology, risk factors, prevention, and management. Major findings include insights into the mechanisms of RC development, promising preventive and therapeutic approaches, and the importance of standardized treatment pathways. Future research should focus on identifying genetic risk factors, improving treatment efficacy, and enhancing patient outcomes. This review offers valuable insights for clinicians and researchers, guiding future investigations into radiation cystitis management.

National Trends of Inpatient Radiation Cystitis: 2016-2019.

INTRODUCTION: Radiation cystitis with hematuria (RCH) is a potentially devastating complication after pelvic radiation. The cumulative incidence of RCH is debated, and certain severe manifestations may require hospital admission. We aimed to evaluate demographics and outcomes of patients hospitalized for RCH. METHODS: We performed a retrospective review of hospitalized patients with a primary or secondary diagnosis of RCH from 2016 to 2019 using the National Inpatient Sample. Our unit of analysis was inpatient encounters. Our primary outcome was inpatient mortality. Secondary outcomes included need for inpatient procedures, transfusion, length of stay (LOS), and cost of admission. We then performed multivariate analysis using either a logistic or linear regression to identify predictors of mortality and LOS. Cost was analyzed using a generalized linear model controlling for LOS. RESULTS: We identified 21,320 weighted cases of hospitalized patients with RCH. The average patient age was 75.4 years, with 84.7% male and 69.3% White. The median LOS was 4 days, and the median cost was $8767. The inpatient mortality rate was 1.3%. The only significant predictor for mortality was older age. The only significant predictor of both higher cost and longer LOS was an Elixhauser Comorbidity Score ≥ 3. CONCLUSIONS: RCH represents a significant burden to patients and the health care system, and we observed an increasing number of hospitalized patients over time. Additional research is needed to identify underlying causes of RCH and effective treatments for this sometimes-severe complication of pelvic radiation.

Assessing the safety of minimally invasive partial nephrectomy in octogenarians.

As life expectancy continues to rise, there is a growing cohort of octogenarians that can have oncologic benefit from a partial nephrectomy. This study aims to analyze a large national dataset to compare the safety and outcomes in octogenarians receiving a nephrectomy. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was utilized. All subjects 80-89 years old who received a minimally invasive partial nephrectomy (CPT: 50543) or radical nephrectomy (CPT: 50545, 50546) from 2016 to 2020 were included. Baseline characteristics, comorbidities, and postoperative complications were compared. Chi-square analysis and student t-tests were used to analyze categorical and continuous variables, respectively. 1765 procedures were performed on octogenarians, of which 1299 (73.6%) received a radical nephrectomy and 466 (26.4%) received a partial nephrectomy. When comparing preoperative comorbidities, octogenarians undergoing partial nephrectomy had lower rates of dyspnea at exertion (7.3 vs. 10.6%, p = 0.04), COPD (2.8 vs. 5.9%, p = 0.01), and chronic steroid use (1.5 vs. 3.3%, p = 0.04). No statistically significant differences were seen in any minor (Clavien 1/2) or major post-operative complications (Clavien 3/4). Readmissions were higher in those who received a partial nephrectomy (10.5 vs. 6.5%, p = 0.01); however, there were no significant differences in reoperation (2.4 vs. 1.7%, p = 0.36) or mortality (1.3 vs. 1.8%, p = 0.48). Partial nephrectomy is a safe and feasible operation in octogenarians. Preoperative counseling and appropriate patient selection remain imperative.