The etiology of the radiation cystitis is a pelvic irradiation generally performed as part of
the treatment of prostate cancer. The incidence is 50,000 new cases per year. Approximately
35% of prostate cancer treatment is radiotherapy. The prevalence of haematuric radiation
cystitis is 4-5% (about 800 patients).
One of the complications of radiation cystitis is persistent hematuria. There is currently no
curative treatment for this hematuria. There are few treatment options with a random
probability of improvement of this symptomatology. These haematurias are rarely resolved
spontaneously and most of the time involve emergency room management with +/- invasive
procedures, sometimes by hospitalisation, always with a significant psychological impact on
the patient.
Furthermore, lifetime anticoagulant treatment considerably increases the likelihood of
bladder bleeding. This is the case of patients being followed for Atrial Fibrillation Cardiac
Arrhythmia (AFCA), which by definition carries a major cardioembolic risk, and who will be of
particular interest in this study.
In recent years, cardiologists have developed an alternative to anticoagulants: left atrial
appendage closure or left atrial occlusion (LAO) . This procedure consists of inserting a
nitinol prosthesis in the left atrium, the site of more than 90% of thrombi formation in
non-valvular atrial fibrillation. This minimally invasive procedure lasts about 15 minutes
and is performed during a 48-hour hospitalization. Anticoagulants are stopped the day after
the setting up procedure. Several studies have shown non-inferiority of atrial closure and
anticoagulants to thromboembolic events in non-valvular atrial fibrillation. In addition, LAO
allows the permanent discontinuation of anticoagulants, associated with the cessation of
anticoagulant bleeding adverse events.
While studies have been conducted on the impact of this technique on patients monitored in
cardiology, no studies evaluate the value of LAO in anticoagulated patients with a hematuric
radiation cystitis. This tprocedure is already used in routine care for patients followed in
urology, and has shown encouraging results, since 8 out of 10 patients saw a significant
reduction in the number of haematurias, but it has never yet been scientifically proven to be
effective, hence the aim of this study.
The interest of this study will therefore be :
To evaluate the potential benefit of left atrial appendage closure on the number of
episodes of hematuria.
To evaluate the economic benefit in reducing the number of hospitalizations, surgeries
and complications for hematuria as well as the discontinuation of anticoagulants.
As the patient's data must be retrieved regardless of the patient's subsequent management
(with or without a cardiac procedure) within the framework of the HEMOCC protocol, it will be
proposed to the patient as soon as he or she is consulting for haematuria on radiation
cystitis. The patient will be followed for 3 years.
The mainly descriptive analyses will be collected in the form of a register and carried out
by a biostatistician from Clermont-Ferrand University Hospital.