Shao
Intravesical instillation of hyaluronic acid as effective as hyperbaric oxygen for radiation-induced haemorrhagic cystitis
| 1. Both treatments were equally effective in improving symptoms of haematuria, dysuria and pelvic pain in patients with radiation-induced hemorrhagic cystitis. **2. No improvements in frequency was noted in patients of either group at 18 months **post-treatment |
Citation: 1.Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int. 2012 Mar; 109(5):691-4. doi: 10.1111/j.1464-410X.2011.10550.x. Epub 2011 Sep 2. 2.Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation‐induced hemorrhagic cystitis. BJU international. 2012 Mar 1;109(5):691-4.
Lead author's name and fax: Yuan Shao: shenzhoujun@hotmail.com
Three-part Clinical Question: For patients with radiation-induced haemorrhagic cystitis (HC), does treatment with intravesicular hyaluronic acid (HA), compared with HBOT, reduce the symptoms of HC?Search Terms: Intravesical hyaluronic acid instillation, hematuria, radiation-induced hemorrhagic cystitis
The Study: Non-blinded randomised controlled trial without intention-to-treat.The Study Patients: Patients who developed HC after radiotherapy for pelvic malignancies Control group (N = 20; 20 analysed): 30 daily sessions at 2.5ATA breathing 100% oxygen for 60 minutes Experimental group (N = 16; 16 analysed): Intravesicular instillation of 40mg of HA weekly in the first month and subsequently monthly in the following 2 months.
- The Evidence:
| Outcome | Time to Outcome | Control group | HA group | Relative risk reduction | Absolute risk reduction | NNT |
| Complete response | 18 months | 0.45 | 0.5 | 11% | 0.05 | 20 |
| ^ | 95% CI: | -62% to 84% | -0.28 to 0.38 | NNT 3 to INF; NNH 4 to INF | ||
| No clots, but macroscopic haematuria persisting | 18 months | 0.30 | 0.25 | 17% | 0.05 | 20 |
| ^ | 95% CI: | -81% to 100% | -0.24 to 0.34 | NNT 3 to INF; NNH 4 to INF |
| Outcome | HBOT Group | HA Group | Difference | 95% CI | ||
| ^ | Mean | SD | Mean | SD | ^ | ^ |
| Visual analogue scale (pelvic pain) at 18 months **(0 to 10) |
1.35 | 1.69 | 1.25 | 1.53 | 0.10 | -1.01 to 1.21 |
| Urinary Frequency at 18 months (Voids per day) | 10.0 | 1.97 | 10.3 | 1.5 | -0.30 | -1.51 to 0.91 |
- Comments:
1. The exclusion criteria of this study (if any) were not mentioned in the report 2. 25% of patients did not benefit in either group with respect to haematuria symptoms 3. Decrease in frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy
Appraised by: Bryan Hui; Tuesday, 30 April 2013 Email: bryan.hui@student.unsw.edu.au Kill or Update By: December 2019
