Tesis

Intravesical Hyaluronic Acid Instillation as A Treatment of Radiation Induced Cystitis: A Systematic Review = Instilasi Asam Hyaluronat Intravesikal sebagai Terapi Sistitis Radiasi: Sebuah Tinjauan Sistematis.

Introduction : Radiation cystitis is a recognized complication of pelvic radiotherapy procedure commonly from prostate, bladder, rectal or uterine cancers. It’s incidence ranges from 23%-80%. The symptoms can occur within three to six months of radiation treatment or late symptoms that occur after six months even as late as 2 decades after therapy. Instillation of hyaluronic acid has been developed to temporarily replenished GAG layer and has successfully used as a treatment for interstitial cystitis. Several studies have been conducted to see the effect of intravesical hyaluronic acid specifically for radiation induced cystitis. Methods: : A systematic search of the literature was conducted in May 2021 using Medline/PubMed, Scopus and ProQuest. The keywords included “sodium hyaluronate”, “hyaluronic acid”, “radiation cystitis” and “treatment”. Results: : After the systematic search using keywords mentioned above, there were 6 studies available for analysis. Three studies used 40 mg/ 50 ml dose of hyaluronic acid, while the other three used similar dose with additional therapies. The studies show improvement of dysuria and bladder capacity. One study reported increase of bladder capacity from 85 to 243.3 mL and improvement of VAS score from initial mean 8.6 to 1. Other study also showed resolution of frequency and overactive bladder symptoms. Conclusion: Hyaluronic acid is showing promising result in treating radiation cystitis, however more long-term and comparative studies are needed to observe its optimal duration and long-term effect.
Keywords: Radiation cystitis, Pelvic radiotherapy, Hyaluronic acid instillation, Intravesical therapy, Systematic review


Pendahuluan: Sistitis radiasi merupakan komplikasi yang telah dikenal dari terapi radiasi pelvis, umumnya pada kanker prostat, kandung kemih, rektum, atau uterus, dengan insidensi 23%–80%. Gejala dapat muncul dalam 3–6 bulan setelah terapi radiasi atau sebagai gejala tardif ≥ 6 bulan hingga dua dekade pascaterapi. Instilasi asam hialuronat telah dikembangkan untuk sementara mengembalikan lapisan glikosaminoglikan (GAG) dan telah berhasil digunakan pada sistitis interstisial. Beberapa penelitian telah menilai efek asam hialuronat intravesika khususnya untuk sistitis akibat radiasi. Metode: Pencarian sistematis literatur dilakukan pada Mei 2021 melalui Medline/PubMed, Scopus, dan ProQuest dengan kata kunci “sodium hyaluronate”, “hyaluronic acid”, “radiation cystitis”, dan “treatment”. Hasil: Dari pencarian sistematis tersebut, diperoleh 6 studi untuk dianalisis. Tiga studi menggunakan dosis asam hialuronat 40 mg/50 mL, sedangkan tiga studi lain menggunakan dosis serupa dengan terapi tambahan. Seluruh studi menunjukkan perbaikan disuria dan kapasitas kandung kemih. Satu studi melaporkan peningkatan kapasitas kandung kemih dari 85 mL menjadi 243,3 mL serta penurunan skor VAS nyeri dari rata-rata 8,6 menjadi 1. Studi lain menunjukkan resolusi frekuensi miksi dan gejala kandung kemih overaktif. Kesimpulan: Asam hialuronat menunjukkan hasil menjanjikan dalam penatalaksanaan sistitis radiasi; namun diperlukan penelitian komparatif dan jangka panjang untuk menentukan durasi optimal dan efek berkelanjutan terapi ini.
Kata Kunci: Sistitis radiasi, Radioterapi pelvis, Instilasi asam hialuronat, Terapi intravesika, Tinjauan sistematis