Shao
Intravesical instillation of hyaluronic acid as effective as hyperbaric oxygen for radiation-induced haemorrhagic cystitis
Clinical Bottom Line:
| 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 after 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. |
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
