Overview

Some cancer treatments may cause problems with your bladder. Specifically, some chemotherapy drugs, treatments delivered into your bladder and/or radiation to the pelvis can cause an irritation to the lining of your bladder, called cystitis. Cystitis can be severe, causing your bladder to bleed and increasing your risk of infection. This condition can be life-threatening. There is no treatment to reverse cystitis. Tell you doctor immediately if you have cystitis symptoms so that the treatment causing it can be stopped. Preventive measures may be taken if your treatment is likely to cause cystitis.

What bladder problems may occur as side effects of cancer treatment?

Irritation of the lining of the bladder is called cystitis. This condition is commonly caused by a urinary tract infection, where bacteria have infected your bladder. However, it is also a side effect of some cancer treatments. Cancer patients in particular are at increased risk of developing a more severe form of cystitis called hemorrhagic (bleeding) cystitis. This condition may occur during treatment, immediately following treatment or months after treatment. Hemorrhagic cystitis can be a very serious condition leading to significant bleeding and/or life-threatening infection.

Which cancer treatments cause cystitis?

Cystitis in cancer patients is often caused by treatment with the chemotherapy drugs cyclophosphamide and ifosfamide, administration of treatments directly into the bladder, or radiation therapy to the pelvic region.

Cyclophosphamide and ifosfamide: Cystitis is commonly caused by treatment with the chemotherapy drugs cyclophosphamide and ifosfamide. Drugs are broken down in the body to substances called metabolites. Acrolein is a metabolite produced when cyclophosphamide and ifosfamide are broken down. This metabolite is cleared from the body in the urine and irritates the lining of the bladder as it is being passed.

High-dose chemotherapy prior to stem cell transplant: High-dose cyclophosphamide and/or busulfan is often administered in conjunction with a stem cell transplant. This treatment is associated with significant, and sometimes life-threatening hemorrhagic cystitis.[1]

Delivery of treatment directly into the bladder: A treatment for superficial bladder cancer is to deliver chemotherapy directly into the bladder, called intravesical installation. This is done by passing the chemotherapy through a catheter in the urethra, the tube that carries urine from the bladder. This approach delivers the chemotherapy drugs at full strength directly to the cancer, but may also irritate the lining of the bladder. The drugs commonly used for this approach are mitomycin-C (Mutamycin®), thiotepa (Thioplex®) or doxorubicin (Adriamycin®).

Another treatment that is delivered directly into the bladder is the bacteria that causes tuberculosis, called bacillus Calmette-Guerin (BCG). This treatment is also known to cause cystitis.[2]

Radiation therapy: Cystitis may also occur when radiation therapy is delivered to the pelvic region, as with treatment for bladder or prostate cancers. Symptoms of cystitis caused by radiation may not appear until many months after treatment.

What are the symptoms of cystitis?

Symptoms of cystitis may include:

  • Urinary frequency
  • Urinary urgency
  • Burning with urination
  • Painful urination
  • Inability to empty the bladder completely
  • Urinary incontinence
  • Blood in the urine
  • Abdominal pain

Hemorrhagic cystitis is marked by excessive bleeding from the bladder, and requires immediate treatment. Notify your doctor if you have any of these symptoms.

How can bladder problems be treated?

While there is no treatment to reverse cystitis, the first step is to stop the treatment that is causing it. If you have hemorrhagic cystitis, which is usually accompanied with copious bleeding from the bladder, your doctor may administer a drug into your bladder to stop the bleeding. Other treatments are aimed at managing symptoms, such as acetaminophen (Tylenol®) or other pain relievers for pain and antibiotics for infection.

How can cystitis be prevented?

Three treatments have been shown to help prevent cystitis, the drug mesnex (Mesna®), intravenous (IV) hyperhydration and continuous bladder irrigation.

Mesnex: The drug mesnex has been shown to prevent cyclophosphamide- and ifosfamide-induced cystitis.[3],[4] This drug works by binding to the metabolite acrolein in the bladder to form an inactive product that is then excreted. In this way, the bladder is protected, but the antitumor activity of the chemotherapy drug remains the same.

Hyperhydration: Another approach to preventing hemorrhagic cystitis is to increase fluid intake to help flush the bladder. Researchers have shown that hyperhydration by IV saline with administration of furosemide (Lasix®), a diuretic drug to maintain a urine output, effectively prevented hemorrhagic cystitis in patients who received high-dose cyclophosphamide before a bone marrow transplant.[5]

Continuous bladder irrigation: Cystitis may also be prevented by continuously flushing the bladder, also called continuous bladder irrigation. This technique has been shown to decrease the incidence of hemorrhagic cystitis in patients receiving a stem cell transplant.1

What else can I do?

Drinking plenty of fluids may also help to “flush” the bladder and prevent cystitis.

References

[1]Turkeri LN, Lum LG, Uberti JP, Abella E, et al. Prevention of hemorrhagic cystitis following allogeneic bone marrow transplant preparative regimens with cyclophosphamide and busulfan: role of continuous bladder irrigation. J Urol. 1995;153:637-40.

[2] Drake MJ, Nixon PM, Crew JP. Drug-induced bladder and urinary disorders. Incidence, prevention and management. Drug Saf. 1998;19(1):45-55.

[3]Khojasteh NH, Zakerinia M, Ramzi M, Haghshenas M. A new regimen of MESNA (2-mercaptoethanesulfonate) effectively prevents cyclophosphamide-induced hemorrhagic cystitis in bone marrow transplant recipients. Transplant Proc. 2000 May; 32(3): 596.

[4] Cohen MH, Dagher R, Griebel DJ, Ibrahim A, et al. U.S. Food and Drug Administration drug approval summaries: imatinib mesylate, mesna tablets, and zoledronic acid. Oncologist. 2002; 7(5): 393-400.

[5]Ballen KK, Becker P, Levebvre K, Emmons R, et al. Safety and cost of hyperhydration for the prevention of hemorrhagic cystitis in bone marrow transplant recipients. Oncology. 1999 Nov; 57(4): 287-92.