Management and recurrence patterns of radiation-induced cystitis with hematuria: a persistent clinical challenge

Introduction: Radiation-induced cystitis (RIC) with gross hematuria is a challenging complication in patients undergoing pelvic radiotherapy (RT), often resulting in emergency department (ED) visits and hospital admissions. Materials and methods: We retrospectively reviewed records of patients who received pelvic RT and accessed our ED for RIC between 2019 and 2024. Demographic and clinical data were collected. The primary aim was to evaluate ED management, hospitalization rates, in-hospital care and discharge treatments. Moreover, multivariable Cox-regression (MCR) and Poisson regression analyses were used to identify predictors of recurrent ED visits and number of total hospitalizations. Results: Overall, 61 patients were identified. Median age at first RIC was 75 years, with a median interval of 7 years (IQR: 2–9) from RT to RIC onset. Among these, 54 (89%) received RT for prostate cancer. At first ED presentation, 25 (41%) had a prior history of RIC. Overall, 32 (52%) required hospitalization. At MCR, age (HR: 1.01, p = 0.03) and anticoagulant/antiplatelet use (HR: 1.8, p = 0.01) were significantly associated with recurrence. Similarly, Poisson regression showed that higher age (RR:1.1, p = 0.02), anticoagulant/antiplatelet therapy (RR:1.6, p = 0.008), prior RIC (RR:2.2, p < 0.001) and longer latency from RT to RIC (RR: 1.3, p = 0.04) were significantly associated to increased risk of multiple hospitalizations. Conclusion: Older age, anticoagulant or antiplatelet use, previous RIC, and delayed RIC onset are independent predictors of multiple hospitalizations. These results highlight the long-term impact of RT-related complications in these patients and the need for improved preventive strategies.