Abstract
Hemorrhagic cystitis is a rare and severe late complication of pelvic radiation, and there is no regulatory-approved drug treatment. We present an 81-year-old man with a history of localized prostate cancer, which was treated with external beam radiation therapy and subsequently developed severe hemorrhagic radiation cystitis for which he has failed several treatments. We present the novel use of intravesical tacrolimus for the treatment of refractory radiation cystitis and gross hematuria. The patient tolerated the treatment well, and it resulted in the resolution of his gross hematuria without further consideration for formalin instillation or cystectomy and diversion. Intravesical tacrolimus is a safe, minimally invasive, and promising treatment option for radiation hemorrhagic cystitis.
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References
Rajaganapathy BR, Jayabalan N, Tyagi P et al (2014) Advances in therapeutic development for radiation cystitis. Lower Urin Tract Symptoms 6:1–10
Gorczynska E, Turkiewicz D, Rybka K (2005) Incidence, clinical outcome, and management of virus-induced hemorrhagic cystitis in children and adolescents after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 11:797–804
Manikandan R, Kumar S, Dorairajan LN (2010) Hemorrhagic cystitis: a challenge to the urologist. Indian J Urol 26:159–166
Chong KT, Hampson NB, Corman JM (2005) Early hyperbaric oxygen therapy improves outcome for radiation-induced hemorrhagic cystitis. Urology 65:649–653
Smit SG, Heyns CF (2010) Management of radiation cystitis. Nat Rev Urol 7:206–214
Rico MJ, Lawrence I (2002) Tacrolimus ointment for the treatment of atopic dermatitis: clinical and pharmacologic effects. Allergy Asthma Proc 23:191–197
Naesens M, Kuypers DR, Sarwal M (2009) Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol 4:481–508
Ebert AK, Rosch WH, Vogt T (2008) Safety and tolerability of adjuvant topical tacrolimus treatment in boys with lichen sclerosus: a prospective phase 2 study. Eur Urol 54:932–937
Rajaganapathy BR, Janicki JJ, Levanovich P et al (2015) Intravesical liposomal tacrolimus protects against radiation cystitis induced by 3-beam targeted bladder radiation. J Urol 194:578–584
Chuang Y, Tyagi P, Huang H et al (2011) Intravesical immune suppression by liposomal tacrolimus in cyclophosphamide-induced inflammatory cystitis. Neurourol Urodyn 30:421–427
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Michael B. Chancellor has financial interest with Lipella Pharmaceuticals, Inc. There are no other conflicts of interests related to this publication to report.
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This letter does not contain any studies with human participants or animals performed by any of the authors.
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Dave, C.N., Chaus, F., Chancellor, M.B. et al. Innovative use of intravesical tacrolimus for hemorrhagic radiation cystitis. Int Urol Nephrol 47, 1679–1681 (2015). https://doi.org/10.1007/s11255-015-1098-6
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DOI: https://doi.org/10.1007/s11255-015-1098-6