膀胱內玻尿酸灌注治療放射性膀胱炎之臨床療效分析：回顧性真實世界研究

蔡悅文¹、謝佳駤²、李高漢²、劉建良^2,3、黃冠華²、邱文祥⁴

¹台南永康奇美醫院 教學部 一般科；²台南永康奇美醫院 外科部 泌尿科；³台南永康奇美醫院 外科部 泌尿腫瘤科；新光吳火獅紀念醫院 外科部 泌尿科

Clinical Efficacy of Intravesical Hyaluronic Acid Instillation in Patients with Radiation-Induced Cystitis: A Retrospective Real-World Study

Yueh-Wen Tsai¹、Chia-Chih Hsieh²、Kau-Han Lee ²、Chien-Liang Liu ^2,3、Steven K. Huang²、Allen W. Chiu ⁴

¹Department of General Medicine, Chi Mei Medical Center, Tainan, Taiwan;

²Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

³Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

⁴Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Purpose: Radiation-induced cystitis (RC) is a late-onset complication of pelvic radiotherapy, often presenting with severe hematuria. This study evaluates the efficacy of intravesical Hyaluronic Acid (HA) instillation in reducing clinical burdens, including ER visits, surgical interventions, and hospital admissions.

Materials and Methods: We retrospectively reviewed 18 patients diagnosed with RC who received intravesical HA therapy between August 2021 and February 2026 at our center. Comprehensive demographic data, including age at onset, radiation dosage, and latency period, were collected. Clinical burdens were quantified by comparing the event rates of hematuria-related ER visits, TUR for bleeding, and inpatient admissions before and after HA initiation. Event rates were standardized per month to account for varying follow-up durations. Statistical analyses were performed using the Wilcoxon signed-rank test for paired comparisons and Spearman’s rank correlation to analyze the relationship between the time from symptom onset to the first HA instillation and the time to clinical resolution.

Results: The mean age of the cohort at the time of RC onset was 77.1 ± 6.5 years. The average radiation dosage was 6705.3 cGy (Median: 7560 cGy), with a mean latency period from radiotherapy to RC onset of 66.7 months (Median: 51.0 months). Regarding combined treatments, 9 patients (50%) received hyperbaric oxygen therapy (HBOT). Prior to HA instillation, patients experienced significant clinical burdens, with a mean of 2.39 ER visits (IQR: 1.0–3.0), 1.89 TUR procedures for bleeding control (IQR: 1.0–2.0), and 1.83 hospital admissions (IQR: 1.0–2.8). Following HA therapy, a dramatic reduction was observed across all clinical outcomes (p < 0.001 for all). The standardized monthly ER visit rate decreased from 0.94 to 0.13 (p = 0.0009), the monthly TUR bleeding control rate fell from 1.00 to 0.06 (p < 0.0001), and the monthly admission rate dropped from 0.92 to 0.07 (p < 0.0001). The overall clinical response rate was 94.4%. Among responders, the median time from the initiation of HA therapy to hematuria resolution was 1.0 month (IQR: 1.0 – 4.25 months). The median number of HA instillations required to achieve clinical resolution was 3 sessions (IQR: 1.75–7.0). Spearman’s rank correlation revealed a moderate positive association between the duration from symptom onset to first HA instillation and the time required for resolution (ρ= 0.453, p = 0.078), suggesting that earlier initiation of HA therapy may be associated with a shorter recovery period.

Conclusions: Intravesical HA instillation significantly mitigates the clinical burden of radiation-induced cystitis by reducing the necessity for emergency care, invasive surgery, and hospitalization. suggesting that earlier initiation of HA therapy may be associated with a shorter recovery period. Our findings suggest a potential link between treatment timing and recovery speed. Early initiation of HA instillation should be considered in the management of radiation cystitis to potentially shorten the duration of symptoms and improve therapeutic efficiency.