Radiation-induced cystitis is a condition commonly seen in patients who have undergone radiation therapy, especially those treated in the pelvic region. Symptoms typically manifest after radiation exposure and may include dysuria (painful urination), increased urinary frequency during both day and night, and hematuria (blood in the urine), which can range from mild to severe.

Currently, treatment is symptomatic, as there is no definitive cure for radiation cystitis. Management includes medications to alleviate symptoms, cystoscopic interventions to control bleeding, intravesical instillations, and in severe cases, surgical procedures to divert the urinary tract.

Recently, low-intensity extracorporeal shock wave therapy (Li-ESWT) has been used to treat various urological conditions, including chronic prostatitis, chronic cystitis, overactive bladder, erectile dysfunction, and as an adjunct to enhance drug delivery into the bladder. This modality has shown potential to reduce inflammation, promote angiogenesis (formation of new blood vessels), regenerate tissues, and restore neural function.

For patients with radiation cystitis, particularly those with prostate cancer who have received pelvic radiation, shock wave therapy is being explored for its ability to alleviate bladder pain and inflammation. This approach is similar to its use in non-bacterial cystitis and overactive bladder conditions.

Studies have identified elevated levels of specific proteins in the urine of patients with radiation-induced cystitis, including markers of fibrosis, angiogenesis, and inflammation, which differ from those found in non-irradiated individuals.

The anticipated benefit of this study is to provide data on clinical symptoms and treatment safety, potentially offering a novel therapeutic strategy for managing radiation-induced cystitis.

Inclusion Criteria:

• Criteria for diagnosis of radiation-induced cystitis and a history of pelvic radiation therapy administered more than 6 months prior.
• Aged 18 years or older.
• Willing to participate in the research study by providing written informed consent.

Exclusion Criteria:

• Active urinary tract infection within the past 6 months.
• Active and uncontrolled gross hematuria.
• Patients currently have a urinary diversion or abdominal ostomy.
• Patients with anuria due to chronic kidney failure.
• Uncontrolled coagulopathy.
• Refuse participation, withdraw from the study, or experience severe adverse effects.

We are still evaluating whether to share individual participant data (IPD) from this study on low-intensity extracorporeal shock wave therapy (Li-ESWT) for radiation-induced cystitis. Key considerations include ensuring adequate de-identification of sensitive clinical data, addressing patient consent for secondary use, and complying with institutional and ethical guidelines. Additionally, due to the relatively small sample size and the potential for indirect re-identification, we are carefully assessing the risks and benefits of IPD sharing. A decision will be made once these factors have been thoroughly reviewed in consultation with our ethics board and institutional data governance policies.