Laparoscopic Cystoprostatectomy for Radiation-Induced Hemorrhagic Cystitis

Abstract

Hemorrhagic cystitis after radiotherapy is a relatively rare event, usually occurring several years after radiation treatment. It can be relentlessly progressive, and treatment options are usually suboptimal. No management strategy is fully successful, and a stepwise progression in treatment intensity is often necessary with cystectomy and urinary diversion being the final management option. Laparoscopic cystoprostatectomy with minilaparotomy ileal conduit urinary diversion was successfully performed in three patients with severe refractory hemorrhagic cystitis secondary to radiation treatment for prostate cancer. More conservative management had failed in all three patients with continued severe and life-threatening bleeding. No intraoperative complications were encountered in spite of the obliteration of tissue planes after radiation treatment. Mean operative time was 4 hours and 45 minutes, including the urinary diversion. Blood loss ranged from 50 to 200 mL. Postoperative recovery was uneventful with the exception of prolonged ileus in one patient, which resolved conservatively. Radiation treatment for prostate cancer is not an absolute contraindication for laparoscopic cystoprostatectomy, which can still be safely performed in some of these patients. Extension of this experience to patients with malignant disease remains to be evaluated.