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Efficacy and Survival Associated With Cystoscopy and Clot Evacuation for Radiation or Cyclophosphamide Induced Hemorrhagic Cystitis

2008; Lippincott Williams & Wilkins; Volume: 181; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2008.10.037

1527-3792

Joshua R. Kaplan, J. Stuart Wolf,

Urological Disorders and Treatments

No AccessJournal of UrologyAdult Urology1 Feb 2009Efficacy and Survival Associated With Cystoscopy and Clot Evacuation for Radiation or Cyclophosphamide Induced Hemorrhagic Cystitis Joshua R. Kaplan and J. Stuart Wolf Joshua R. KaplanJoshua R. Kaplan and J. Stuart WolfJ. Stuart Wolf View All Author Informationhttps://doi.org/10.1016/j.juro.2008.10.037AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed the outcome of patients with hemorrhagic cystitis severe enough to require cystoscopy and clot evacuation. Materials and Methods: We retrospectively evaluated the records of 33 patients with cyclophosphamide or radiation induced hemorrhagic cystitis treated with cystoscopy. Results: Mean followup of living patients was 76 months. Of 33 patients 20 (61%) had resolution of hematuria after single cystoscopy unrelated to hemorrhagic cystitis etiology. Only 4 of 11 patients (36%) had resolution after 2 or more cystoscopies, and all were in the radiation induced hemorrhagic cystitis group (4 of 6, 67%) with none in the cyclophosphamide induced hemorrhagic cystitis group (0 of 5, p = 0.02). Hematuria was refractory to cystoscopy in 9 patients and ileal conduits were created in 4. Kaplan-Meier overall survival at 1, 2 and 5 years was 58%, 51% and 43%, respectively, with survival tending to be worse in patients who received cyclophosphamide for bone marrow transplantation induction. Of the 18 deaths 3 were due to complications of hemorrhagic cystitis, 13 were due to the disease underlying the hemorrhagic cystitis and 2 were unrelated. Conclusions: The response of hemorrhagic cystitis to single cystoscopy and clot evacuation is reasonable but response to subsequent cystoscopy (unless the hemorrhagic cystitis is radiation induced) is less likely, so alternate interventions should be considered if hematuria does not resolve after intial cystoscopy. Patients with hemorrhagic cystitis requiring cystoscopy have a poor prognosis even if hematuria resolves, although most deaths are related to the disease underlying the hemorrhagic cystitis rather than its direct result. References 1 : Hemorrhagic cystitis: etiology and treatment. Prog Urol2001; 11: 591. Google Scholar 2 : BK DNA viral load in plasma: evidence for an association with hemorrhagic cystitis in allogeneic hematopoietic cell transplant recipients. Blood2005; 106: 1130. Google Scholar 3 : Atorvastatin-induced hemorrhagic cystitis: a case report. Urology. : 2008. Epub ahead of print. Google Scholar 4 : Hemorrhagic cystitis: a review. J Urol1990; 143: 1. Link, Google Scholar 5 : Radiation-induced haemorrhagic cystitis. Eur Urol2001; 40: 111. Google Scholar 6 : Cyclophosphamide induced hemorrhagic cystitis. J Urol1999; 161: 1747. Link, Google Scholar 7 : Cyclophosphamide associated bladder cancer–a highly aggressive disease: analysis of 12 cases. J Urol1996; 156: 1931. Link, Google Scholar 8 : Pathophysiological aspects of cyclophosphamide and ifosfamide induced hemorrhagic cystitis; implication of reactive oxygen and nitrogen species as well as PARP activation. Cell Biol Toxicol2007; 23: 303. Google Scholar 9 : Hemorrhagic cystitis after high dose chemotherapy: An interdisciplinary problem. Urologe A1998; 37: 516. Google Scholar 10 : Continuous bladder irrigation prevents hemorrhagic cystitis after allogeneic hematopoietic cell transplantation. Urol Oncol2008; 26: 43. Google Scholar 11 : Early hyperbaric oxygen therapy improves outcome for radiation-induced hemorrhagic cystitis. Urology2005; 65: 649. Google Scholar 12 : Hemorrhagic Cystitis. AUA Update Series2007; 26. lesson 7. Google Scholar 13 : Formalin treatment for intractable hemorrhagic cystitis: a review of the literature with 16 additional cases. Cancer1976; 38: 1785. Google Scholar 14 : Prostaglandin E2 bladder instillation for the treatment of hemorrhagic cystitis after allogeneic bone marrow transplantation. Haematologica1995; 80: 421. Google Scholar 15 : Prevention and management of BK-virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation–a systematic review and evidence-based guidance for clinical management. Br J Haematol2008; 142: 717. Google Scholar 16 : Urological complications of cyclophosphamide. Br J Urol1973; 45: 606. Google Scholar 17 : Cyclophosphamide and urinary bladder toxicity. Cancer Res1961; 21: 1577. Medline, Google Scholar 18 : Cyclophosphamide-induced hemorrhagic cystitis: A review of 100 patients. Cancer1988; 61: 451. Google Scholar 19 : Hemorrhagic cystitis: a retrospective single-center survey. Clin Transplant2007; 21: 659. Google Scholar 20 : Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT. Bone Marrow Transplant2008; 41: 881. Google Scholar Department of Urology, University of Michigan Health System, Ann Arbor, Michigan© 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byKiechle J, Kim S, Yu J, Maurice M, Dong S, Cherullo E and Abouassaly R (2016) Economic Burden Associated with Hospitalization for Radiation Cystitis: Results from a Statewide Inpatient DatabaseUrology Practice, VOL. 3, NO. 6, (437-442), Online publication date: 1-Nov-2016. Volume 181Issue 2February 2009Page: 641-646 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordscystitiscyclophosphamideMetricsAuthor Information Joshua R. Kaplan Nothing to disclose. More articles by this author J. Stuart Wolf Financial interest and/or other relationship with Terumo Corporation and Omeros Corporation. More articles by this author Expand All Advertisement PDF downloadLoading ...