針對放射性膀胱炎患者進行膀胱內玻尿酸灌注的
治療成效:單中心研究

陳冠甫¹、林志杰^1,2、張延驊^1,2、鍾孝仁^1,2、黃奕燊^1,2、
黃子豪^1,2、蔡承翰^1,2、陳人傑^1,2、黃志賢^1,2、黃逸修^1,2

¹臺北榮民總醫院泌尿部；
²國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心

Real-World Experience With Intravesical Hyaluronic Acid for Hemorrhagic Radiation Cystitis: A Single Center Experience

Kuan-Fu Chen¹, Chih-Chieh Lin^1,2, Yen-Hwa Chang^1,2, Hsiao-Jen Chung^1,2,
I-Shen Huang^1,2, Tzu-Hao Huang^1,2, Cheng-Han Tsai^1,2, Jen-Chieh Chen^1,2,
William J. Huang^1,2, Eric Yi-Hsiu Huang^1,2

¹ Department of Urology, Taipei Veterans General Hospital;

² Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Radiation-induced hemorrhagic cystitis is a late complication of pelvic radiotherapy (PRT), often presenting as recurrent or refractory gross hematuria that can severely impact quality of life. Conventional treatments include bladder irrigation, transurethral coagulation, and hyperbaric oxygen therapy. Recently, intravesical instillation of hyaluronic acid (HA) has emerged as a promising approach, aiming to restore the bladder’s glycosaminoglycan layer and reduce mucosal inflammation. In this study, we evaluated the clinical outcomes of patients with radiation-induced hemorrhagic cystitis treated with intravesical HA at our institute.

Materials and Methods:

We retrospectively reviewed patients with hemorrhagic cystitis following pelvic radiotherapy who received intravesical HA instillation between February 2023 and July 2025 at our center. Data collected included underlying malignancy, relevant comorbidities, prior PRT dose and indication, emergency department (ED) visits, hospital admissions for hematuria, and management details.

Results:

A total of 14 patients, with a mean age of 74.43±6.95(Range 61.0-89.0) years, developed hemorrhagic cystitis following PRT and received HA instillation. 11(78.5%) patients underwent PRT due to prostate cancer, while other patients received PRT due to urothelial carcinoma and ovarian cancer. 5 patients received PRT as primary treatment, another 5 as adjuvant treatment, and 4 received PRT as therapy for recurrence. The mean dosage of radiation therapy was 67 Gy (95% CI 59.72-74.31). Gross hematuria was noted at a median of 32.2 months (IQR 22.5-79.6) after completion of PRT. Before HA instillation, patients had a mean of 2.93 ED visits (95% CI 1.11–4.75) and 1.71 admissions (95% CI 1.39–2.03), undergoing an average of 1.10 surgical interventions for hematuria control (95% CI 0.73–1.47). Following treatment, 8 patients were completely free of gross hematuria. The median recurrence-free survival following HA instillation was 2.63 months (IQR 1.45–11.09), with a median follow-up duration of 4.24 months (IQR 3.07–11.88). The mean number of ED visits also decreased to 0.64 (95% CI 0.01–1.28) and the mean number of admissions decreased to 0.57 (95% CI 0.04–1.10). Mean number of surgical interventions also decreased to 0.71 (95% CI 0.19–1.24). No severe adverse events related to HA instillation was noted.

Conclusion:

Intravesical hyaluronic acid instillation is a safe and effective way to treat radiation-induced hemorrhagic cystitis with a favorable safety profile. While the short-term response is encouraging, further follow-up and review of more patients are needed to clarify long-term efficacy and identify predictors of sustained remission.