Radiation Cystitis Clinical Presentation

Updated: Mar 15, 2021
  • Author: Nicolas A Muruve, MD, FACS, FRCSC; Chief Editor: Edward David Kim, MD, FACS  more...
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In general, symptoms associated with radiation cystitis can be grouped into acute and late-phase, or chronic, symptoms. Acute symptoms are caused by the inflammatory response to ionizing radiation and are similar to those for any inflammatory process of the bladder. They consist of urgency, frequency, dysuria, and hematuria.

Late-phase, or chronic, symptoms are the end result of the inflammatory process caused by radiation. Ischemia and fibrosis are the main factors responsible for symptoms. As a result, new symptoms can occur years after initial therapy, resulting from bladder contraction, ulcer formation, fistulas, and bladder dysfunction. Therefore, clinical presentation can include any of the following urinary symptoms:

  • Frequency
  • Urgency
  • Dysuria
  • Hematuria
  • Incontinence
  • Pneumaturia
  • Fecaluria


Radiation complications involving the bladder are graded on a scale devised by the Radiation Therapy Oncology Group (RTOG). The scale is as follows:

  • Grade 1 - Any slight epithelial atrophy, microscopic hematuria, mild telangiectasia
  • Grade 2 - Any moderate frequency, generalized telangiectasia, intermittent macroscopic hematuria, intermittent incontinence
  • Grade 3 - Any severe frequency and urgency, severe telangiectasia, persistent incontinence, reduced bladder capacity (< 150mL), frequent hematuria
  • Grade 4 - Any necrosis, fistula, hemorrhagic cystitis, bladder capacity (< 100mL), refractory incontinence requiring catheter or surgical intervention
  • Grade 5 - Death