Macroscopic haematuria from radiation cystitis as a sequalae of radiation therapy is often a challenging condition to manage. Treatments are often unsuccessful in resolving haematuria long-term and patients often require multiple treatments over time. We aimed to determine the efficacy of the various treatment options for radiation cystitis in patients presenting to our specialist radiation cystitis service.

We analysed our prospectively maintained specialist radiation cystitis clinic database for patients treated at our centre between January 2016-July 2023. Data was analysed using SPSS 29.

183 patients were identified for analysis. 143 (78%) were male with a median age of 72 (Range 28-96). The mean time from radiation treatment to symptoms of genitourinary toxicity was 3 years (Range <1 year to 17 years). The primary diagnosis for radiation treatment were bladder cancer 10 (5%), prostate cancer 131 (72%), colorectal cancer 3 (2%), cervical cancer 29 (16%) and endometrial cancer 7 (4%). 85 patients underwent intervention for macroscopic haematuria within our service. Patients often required multiple interventions including blood transfusions (28%), cystodiathermy (45%), Holmium laser ablation (39%), Hyperbaric oxygen therapy (18%), Angioembolisation (12%) and Salvage cystectomy (36%). Success rates in resolving macroscopic haematuria endoscopically was higher for Holmium laser ablation (70%) compared to cystodiathermy (53%). In cases where previous cystodiathermy had failed, further holmium laser ablation was able to provide haematuria resolution in 61% of cases.

Haematuria secondary to radiation cystitis is a difficult condition to manage, often requiring multiple treatments before resolution. Endoscopic treatment via Holmium laser ablation appears to be more efficacious than cystodiathermy for resolving haematuria.