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Moaveni AK, Seyed Taher SF, Ghavamzadeh A, Hamidieh AA, Kajbafzadeh AM. The potential of uroflowmetry to predict and detect hemorrhagic cystitis following hematopoietic stem cell transplantation. J Pediatr Urol 2025; 21:426-433. [PMID: 39603892 DOI: 10.1016/j.jpurol.2024.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 09/28/2024] [Accepted: 11/05/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Hemorrhagic cystitis (HC) is a serious complication following hematopoietic stem cell transplantation (HSCT) associated with significant morbidity and mortality. Early identification of at-risk patients and prompt diagnosis are crucial for effective management. This prospective cohort study evaluated the potential of uroflowmetry as a predictive tool for detecting HC in pediatric HSCT patients. METHODS Thirty-one children who underwent allogeneic HSCT were enrolled. Uroflowmetry was performed on admission (Day 0), post-HSCT Day 1 and Day 15, and at HC onset. Uroflowmetric parameters, including maximum flow rate (Qmax), average flow rate (Qavg), voided volume (VV), and flow curve shape, were compared between HC and non-HC patients. RESULTS The incidence of HC within 100 days post-HSCT was 58 %, with a mean onset time of 35 days. At baseline (Day 0), HC patients had significantly lower Qmax (12.5 vs. 17.8 mL/s), Qavg (6.8 vs. 9.5 mL/s), and VV (185 vs. 245 mL) compared to non-HC patients (all p < 0.05). Age-stratified analysis revealed the observation of these differences across all age groups. At HC onset, compared to Day 0, patients experienced a significant decrease in Qmax (8.7 vs. 12.5 mL/s) and Qavg (4.2 vs. 6.8 mL/s) (both p < 0.05). Flow curve analysis demonstrated a shift from bell-shaped to interrupted curves in HC patients over time. CONCLUSIONS Uroflowmetry can potentially predict and detect HC in pediatric HSCT patients. Lower baseline uroflowmetric parameters may identify patients at higher risk for HC, while a significant decrease in these parameters from baseline may indicate HC onset. Uroflowmetry is a simple, non-invasive tool that can be performed at home and monitored remotely, facilitating early detection and intervention for HC in this population.
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Affiliation(s)
- Amir Kian Moaveni
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farshad Seyed Taher
- Hematology, Oncology, and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology, and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Centre, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Dell'Orso G, Carlucci M, Cesaro S, Olcese E, Balduzzi A, Vendemini F, Catti M, Saglio F, Compagno F, Maximova N, Rabusin M, Menconi MC, Perruccio K, Soncini E, Tambaro FP, Tintori V, Pagliara D, Faraci M. An expert consensus on prevention, diagnosis, and management of hemorrhagic cystitis in pediatric hematopoietic cell transplantation, on behalf of the Infectious Disease and Hematopoietic Cell Transplant Working groups of Italian Pediatric Hematology Oncology Association (AIEOP). Bone Marrow Transplant 2024; 59:1302-1308. [PMID: 38909124 DOI: 10.1038/s41409-024-02320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 06/24/2024]
Abstract
The optimal management of hemorrhagic cystitis (HC) in hematopoietic stem cell transplantation (HCT) is debated, both for early onset HC (EOHC) secondary to chemotherapy toxicity and BK Polyomavirus (BKPyV)-related HC, due to the lack of controlled trials, particularly referred to pediatric setting. Actually, clinical practice is mainly based on guidelines of the European Conference on Infections in Leukemia, 6th edition, which considers both adult and pediatric populations but concludes that, despite much progress in understanding the pathogenesis, epidemiology, and risk factors, this complication still represents a disabling unmet clinical need with limited prophylactic and therapeutic options. Additionally, the Guidelines of the American Society of Clinical Oncology define the management of chemotherapeutic toxicity independently from the patients' population. A panel of experts belonging to the Hematopoietic Cell Transplant and Infectious Disease Working Group (WG) of Associazione Italiana di Emato-Oncologia Pediatrica (AIEOP) developed a consensus to define the best practices in prevention, diagnosis, and management of HC in pediatric HCT setting.
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Affiliation(s)
- Gianluca Dell'Orso
- Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Hematology-Oncology, IRCCS, Istituto Giannina Gaslini, Genova, Italy.
| | - Marcello Carlucci
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Evelina Olcese
- Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Hematology-Oncology, IRCCS, Istituto Giannina Gaslini, Genova, Italy
| | - Adriana Balduzzi
- Pediatric Transplantation Unit, Department of Medicine and Surgery, University of Milan-Bicocca-Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione MBBM/Ospedale San Gerardo, ASST, Monza, Italy
| | - Francesca Vendemini
- Pediatric Transplantation Unit, Department of Medicine and Surgery, University of Milan-Bicocca-Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimo Catti
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Torino, Italy
| | - Francesco Saglio
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O.U. Città della Salute e della Scienza-Regina Margherita Children's Hospital, Torino, Italy
| | - Francesca Compagno
- Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Natalia Maximova
- Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo, ", Trieste, Italy
| | - Marco Rabusin
- Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo, ", Trieste, Italy
| | | | - Katia Perruccio
- Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Elena Soncini
- Pediatric Oncology-Haematology and Bone Marrow Transplantation (BMT) Unit, Spedali Civili di Brescia, Brescia, Italy
| | | | - Veronica Tintori
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation, Meyer Children's University Hospital, Firenze, Italy
| | - Daria Pagliara
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Hematology-Oncology, IRCCS, Istituto Giannina Gaslini, Genova, Italy
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Lopez J, Subramanian T, Durell J, Levyn H, Wong R, Shah J, LaQuaglia MP, Gerstle JT. Posttreatment complications in pediatric cervical neuroblastoma: A retrospective case series at a tertiary cancer center. J Surg Oncol 2024; 129:219-223. [PMID: 37850570 PMCID: PMC11637323 DOI: 10.1002/jso.27482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Neuroblastomas rarely occur as primary tumors in the cervical region. Therefore, very little has been reported regarding treatment strategies, complications, and outcomes of these cervical neuroblastomas. The goal of this study is to review the presentation, management, and outcomes of all primary cervical pediatric neuroblastoma cases at a single tertiary care center. METHODS A retrospective cohort review of all neuroblastoma patients treated at a single center were performed. All patients with primary cervical neuroblastoma were reviewed for demographic information, tumor characteristics, treatment, and outcomes. RESULTS Thirty (1.8%) patients were found to have undergone treatment for cervical neuroblastoma tumors diagnosed on average at 2.1 years old. Most presented with a swollen neck/palpable mass ± Horner's syndrome. Based on features including tumor staging, N-myc proto-oncogene protein (MYCN) amplification status, histology, most were deemed intermediate or high risk. Treatment strategies centered around chemotherapeutic regimens with surgery when possible as well as various adjuvant treatments including radiation therapy, immunotherapy, bone marrow transplant, and a neuroblastoma vaccine. Ten (33.3%) of patients experienced treatment-related complications and four (13.3%) died as a result of their disease progression. All four patients were high-risk patients, two of which had MYCN amplification. CONCLUSION Cervical neuroblastomas generally have favorable outcomes. These tumors can be treated effectively with chemotherapy and surgical intervention with various adjuvant therapies. MYCN amplification and higher stage disease presentation contribute to worse outcomes.
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Affiliation(s)
- Joseph Lopez
- AdventHealth for Children, Department of Pediatric Surgery, Division of Pediatric Head & Neck Surgery, Orlando, FL
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York
| | - Tejas Subramanian
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York
| | - Jonathan Durell
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York
| | - Helena Levyn
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York
| | - Richard Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York
| | - Jatin Shah
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York
| | - Michael P. LaQuaglia
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York
| | - J Ted. Gerstle
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York
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Nappi RE, Martella S, Albani F, Cassani C, Martini E, Landoni F. Hyaluronic Acid: A Valid Therapeutic Option for Early Management of Genitourinary Syndrome of Menopause in Cancer Survivors? Healthcare (Basel) 2022; 10:1528. [PMID: 36011183 PMCID: PMC9408661 DOI: 10.3390/healthcare10081528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Genitourinary syndrome of menopause (GSM) is a chronic condition affecting a large number of women, with a major impact on their urogenital health and sexual function. It occurs at midlife because estrogen levels decline with menopause enhancing aging-related changes of the functional anatomy of the urogenital system. Unfortunately, GSM may occur early in the lifespan of women or be exacerbated following anticancer treatments, such as chemotherapy, ionizing radiation, or surgical removal of reproductive organs. Symptoms of GSM are often under-reported by women, under-estimated and under-diagnosed by health care providers (HCPs), and subsequently under-treated, despite their profound negative impact on the quality of life. The mainstay of vaginal treatments is local estrogen therapy (LET) ensuring an effective management of moderate to severe symptomatic GSM. However, LET is generally contraindicated in women with a history of hormone receptor positive cancer, due to the fear of increased recurrence or possible interference with endocrine adjuvant therapies. Among non-hormonal treatments, hyaluronic acid-based moisturizers have shown promising clinical results both in healthy women and in cancer patients or survivors. Its strong water-binding properties provide lubricating and moisturizing effects, which contribute to maintaining a proper level of hydration and viscoelasticity in several body parts, including the urinary tract and genital tissues. Hyaluronic acid-based moisturizers are effective, safe, and well tolerated; therefore, they may represent a valid option for the early management of GSM-associated symptoms in every woman with a history of cancer who is unable or unwilling to undergo hormone-based therapies. Hence, the aim of this review was to provide an overview of GSM etiology and treatment in women with natural or iatrogenic menopause, with a focus on the use of hyaluronic acid as a prophylactic treatment in the context of an integrated management protocol for cancer patients.
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Affiliation(s)
- Rossella E. Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Unit of Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, 27100 Pavia, Italy
| | - Silvia Martella
- Unit of Preventive Gynecology, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Francesca Albani
- Gynecological Endocrinology Clinic, Unit of Internal Medicine and Endocrinology, IRCCS Maugeri, 27100 Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, 27100 Pavia, Italy
| | - Ellis Martini
- Unit of Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, 27100 Pavia, Italy
| | - Fabio Landoni
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy
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Risk factors associated with hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation. BLOOD SCIENCE 2022; 4:83-88. [PMID: 35957667 PMCID: PMC9362868 DOI: 10.1097/bs9.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022] Open
Abstract
Hemorrhagic cystitis (HC) is a common complication of allogeneic hematopoietic stem cell transplantation (HSCT). The incidence is about 7% to 68%, and some patients have to suffer a long period of frequent, urgent, and painful urination, which brings great pain. This study aimed to analyze risk factors of HC and its effect on patient survival. We collected the medical records of 859 patients who underwent HSCT at our hospital between August 2016 and August 2020. Patients with and without HC were matched using propensity score matching at a 1:1 ratio based on sex, age, and diagnosis, and logistic regression analyses were used to identify factors associated with HC. We used Kaplan–Meier curves to analyze the survival rates of patients in the HC and non-HC groups. We also analyzed the relationship between BK viral load and the occurrence of HC using receiver operating characteristic curve (ROC) analysis. After propensity score matching, there were 131 patients each in the HC and non-HC groups. In the HC group, 89 patients (67.9%) had mild HC (stage II°) and 43 (32.1%) had severe HC (stage III–IV). The median interval between stem cell transplantation and HC development was 31 (3–244) days. Univariate analysis indicated that donor age, hematopoietic stem cell source, HLA, acute graft-versus-host disease, busulfan, anti-thymocyte globulin (ATG), total body irradiation, cytomegalovirus (CMV) (urine), and BK polyomavirus (BKV) (urine) were significantly associated with HC. ATG, CMV (urine), and BKV (urine) were independent risk factors for HC based on the multivariate analysis. The Kaplan–Meier survival analysis showed no significant difference between the HC and non-HC groups (P = .14). The 1- and 2-year survival rates in the HC group were 78.4% and 69.6%, respectively, and the corresponding rates in the non-HC group were 84.4% and 80.7%, respectively. ROC analysis indicated that a urine BKV load of 1 × 107 copies/mL was able to stratify the risk of HC. In conclusion, when the BKV load is >1 × 107, we need to be aware of the potential for the development of HC.
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Yozgat A, Bozkaya I, Aksu T, Isik P, Kanbur M, Tiryaki T, Yarali N, Özbek N. Analysis of hemorrhagic cystitis and BK viremia in children after hematopoietic stem cell transplantation. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Baboudjian M, Fourmarier M, Clement C, Cherasse A, Graziana JP, Bentaleb Y, Rouscoff Y, Ducrocq S, Gondran-Tellier B, Saussine C. Intravesical instillation of high molecular weight sodium hyaluronate in radiation-induced cystitis: a prospective pilot study. World J Urol 2021; 40:141-146. [PMID: 34550425 DOI: 10.1007/s00345-021-03837-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of intravesical instillation of high molecular weight sodium hyaluronate (HMW-HA) for the treatment of radiation-induced cystitis. METHODS This prospective cohort study was conducted in seven centers in France. Eligible patients with radiation-induced cystitis were recruited between April 2020 and March 2021. A sterile disposable 50 ml prefilled solution containing 0.16% (80 mg/50 mL) HMW-HA (INSTYLAN) was instilled weekly into the bladder. The treatment consisted of 6 sessions (V1 to V6). Outcomes were assessed 1 week (V7) and 4 weeks (V8) after the last session and were compared with baseline (V0). The primary endpoint was bladder pain, evaluated by a Questionnaire with 5 closed-ended response options. Secondary endpoints included changes from baseline for hematuria, urinary frequency, and the effect of urgencies on Quality of Life (QoL). Adverse events (AEs) were graded according to the CTCAE 3.0 classification. RESULTS A total of 30 participants were enrolled. The Intent-to-Treat analysis showed a significant reduction in pelvic pain intensity (- 45.81%, p < 0.001), hematuria (- 26.87%, p = 0.008), total 24 h voids (- 23.92%, p < 0.001) and the effect of urgencies on QoL (- 33.92%, p < 0.001) at V7. The improvement for each outcome remained stable during the post-therapeutic period between V7 and V8. Bladder instillation therapy was well-tolerated: two treatment-related AEs (6.6%) were reported corresponding to two grade 1 hematuria. CONCLUSIONS Intravesical instillation of HMW-HA appears to be effective in the treatment of radiation-induced cystitis. Further comparative studies with longer follow-up are needed to confirm our preliminary results.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology and Kidney Transplantation, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France.
| | - Marc Fourmarier
- Department of Urology, CH Aix-Pertuis, Aix-en-Provence, France
| | | | - Arnaud Cherasse
- Department of Urology, Clinique du Val d'Ouest, Ecully, France
| | - Jean-Pierre Graziana
- Department of Urology, Clinique Mutualiste de la Porte de L'Orient, Lorient, France
| | | | | | - Sylvain Ducrocq
- Department of Urology, CH Notre Dame de la Miséricorde, Ajaccio, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Christian Saussine
- Department of Urology, NHC, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Intravesical Instillation of Sodium Hyaluronate (Cystistat®) for the Treatment of Patients with Radiation Cystitis-Randomized Clinical Trial. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.108299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Radiotherapy (RT) is a choice to manage pelvic organ malignancies that can affect bladder; therefore, it causes radiation cystitis with some bothering urinary symptoms and decreasing the patient’s quality of life. Intravesical hyaluronic acid (HA) is an agent with promising results in some studies for cystitis, and Cystistat is a derivative of hyaluronic acid. Objectives: This clinical trial aimed at evaluating the effects of intravesical instillation of Cystistat on symptoms of radiation cystitis and quality of life (QOL). Methods: A total of 58 patients with radiation cystitis were randomized in 2 groups (case: 30, control: 28). One group received intravesical Cystistat, the other received normal saline weekly for up to 4 weeks and then monthly for up to 2 months. Hematuria, Visual Analog scale (VAS) and QOL based on King’s Health questionnaire were compared before and 3, 6 and 9 months after intravesical instillation. Results: The mean age of the patients was 63.93 ± 10.89 years old. The mean of each sub-category of QOL and total score of QOL, as well as, VAS score were significantly improved in comparison to the control group at each time of follow-ups (P < 0.05). Hematuria was significantly different in the 3rd, 6th and 9th month of follow-ups (P < 0.05). Conclusions: Findings showed that patients with radiation cystitis could significantly benefit from intravesical instillation of HA, their hematuria would be successfully resolved rather than control group in addition to lowering the VAS score, so their QOL would be improved.
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Fu JG, Xie KJ. Successful treatment of encrusted cystitis: A case report and review of literature. World J Clin Cases 2020; 8:4234-4244. [PMID: 33024784 PMCID: PMC7520765 DOI: 10.12998/wjcc.v8.i18.4234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/03/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Encrusted cystitis (EC) is a chronic inflammation of the bladder associated with mucosal encrustations. Early diagnosis and optimal treatment are not well established. Here, we report a case of EC successfully treated with com-bination therapy.
CASE SUMMARY A 27-year-old man presented with frequency, urgency, dysuria, gross hematuria and suprapubic pain for 2 mo. He was diagnosed with EC based on characteristic calcifications of the bladder wall (most of them were struvite), cystoscopy and histopathological examination. He was cured after combined therapy of elimination of encrustations, bladder instillation of hyaluronic acid and injection of botulinum-A neurotoxin into bladder submucosal tissue.
CONCLUSION Bladder instillation of hyaluronic acid and injection of botulinum-A neurotoxin into the bladder submucosal tissue can be used for treatment of EC.
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Affiliation(s)
- Jin-Gao Fu
- Department of Urology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen 529000, Guangdong Province, China
| | - Ke-Ji Xie
- Department of Urology, Guangzhou First People’s Hospital, Guangzhou 510180, Guangdong Province, China
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Visintini C, Venturini M, Palese A. Haemorrhagic cystitis, preventive and treatment interventions in patients undergoing haematopoietic stem cell transplantation: A scoping review. Eur J Oncol Nurs 2019; 42:50-62. [PMID: 31446264 DOI: 10.1016/j.ejon.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE to map (a) methodological features, (b) Haemorrhagic Cystitis (HC) preventive and treatment interventions scrutinized to date, (c) outcomes measured, and (d) trends in effectiveness as documented among Haematopoietic Stem Cell Transplanted (HSCT) adults. METHODS A scoping review was performed in 2018. Medline, CINAHL, and Cochrane Systematic Reviews databases were researched using "haemorrhagic cystitis", "prevention", "treatment", "prevent*" and "treat*" as search terms. Handsearching was also performed. Clinical trials, randomized controlled trials, comparative and observational studies, reviews, systematic reviews and meta-analyses published in English and concerning adults were all included. RESULTS Fifteen primary studies, mainly monocentric, retrospective and with a sample size <200, were identified. Seven focused on preventive (mainly continuous bladder irrigation and mesna) and eight on treatment interventions (mainly intravenous and intravesical cidofovir). The onset of micro and macrohaematuria and the clinical resolution of HC were the main measured outcomes. Positive effectiveness trends were apparent for mesna and cidofovir. CONCLUSIONS In HC prevention and treatment, published primary studies are sparse and further research is required with larger, multicenter, and longitudinal designs conducted at international levels, with standardized methods, interventions, outcome measures, and reported data.
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Affiliation(s)
| | | | - Alvisa Palese
- Department of Medical Sciences, Udine University, Italy.
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Nursing Management of Haemorrhagic Cystitis in Patients Undergoing Haematopoietic Stem Cell Transplantation: a Multicentre Italian Survey. Mediterr J Hematol Infect Dis 2019; 11:e2019051. [PMID: 31528317 PMCID: PMC6736169 DOI: 10.4084/mjhid.2019.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/08/2019] [Indexed: 02/07/2023] Open
Abstract
Background Haemorrhagic cystitis (HC) is a severe complication occurring after haematopoietic stem cell transplantation (HSCT) in 13–40% of patients, caused by infectious and/or non-infectious factors that increase the in-hospital length of stay and the risk of mortality of transplanted recipients. Although different management interventions have been suggested in the literature, available knowledge on interventions performed by Italian nurses in their daily practices has not been documented to date. Aim of the study The aim of this study is to describe HC preventive and treatment interventions in patients undergoing HSCT as performed by Italian nurses in their daily practice. Material and methods A multicentre survey was conducted in 2018 by inviting all 110 Italian HSCT centres belonging to the Italian Group for Bone Marrow Transplantation (GITMO). Data collection was performed with an online questionnaire submitted to GITMO reference nurses working in each HSCT centre. Descriptive statistics were performed. Results A total of 38 Italian centres participated. The preventive intervention most applied in daily care was the mesna administration (n=37; 97.4%), followed by intravenous hyperhydration (n=33; 86.8%) and forced diuresis with furosemide (n=24; 63.1%). Preventive continuous bladder irrigation (CBI) was performed in 13 centres (34.2%). Transfusions of blood products (n=32; 84.2%), CBI (n=31; 81.6%) and intravenous hydration (n=28; 73.7%) were the most applied treatments, beyond the administration of analgesics (n=38; 100.0%) and antispasmodics (n=26; 68.4%). Conclusion A great variability both in the HC prevention and treatment interventions applied in daily practice across centres have emerged suggesting that no strong recommendations in the field are available to date. Therefore, there is a need to increase the evidence available in the field by providing methodological studies of higher quality, multicentre and prospective.
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Colombel M, Labussière Wallet H. Cistitis hemorrágica: fisiopatología y conducta práctica. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1761-3310(19)41719-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hannick JH, Koyle MA. Canadian Urological Association Best Practice Report: Pediatric hemorrhagic cystitis. Can Urol Assoc J 2019; 13:E325-E334. [PMID: 31763977 DOI: 10.5489/cuaj.5993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Jessica H Hannick
- Division of Pediatric Urology, UH Rainbow Babies and Children's Hospital, Cleveland, OH, United States.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin A Koyle
- The Hospital for Sick Children, Toronto, ON, Canada.,Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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14
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Wu Q, Zhou F, Song NX, Liu XM, Yu Z, Song XC, Li X, Zhang H. [Clinical features and risk factors of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:187-190. [PMID: 30929383 PMCID: PMC7342539 DOI: 10.3760/cma.j.issn.0253-2727.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Indexed: 12/27/2022]
Abstract
Objective: To explore the relative risk factors, clinical intervention and prognosis of hemorrhagic cystitis (HC) in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: From January 1 2010 to May 31 2017, 425 patients with allo-HSCT received a retrospective analysis. Results: ①Among the 425 patients, 262 were male and 163 were female. The median age was 26 (2-56) years old. There were 138 cases of acute myeloid leukemia (AML) , 96 cases of acute lymphoblastic leukemia (ALL) , 29 cases of myelodysplastic syndrome (MDS) , 98 cases of severe aplastic anemia (SAA) and 64 cases of chronic myeloid leukemia (CML) . 221 cases of sibling match transplantation, 89 cases of unrelated donor transplantation and 115 cases of haplotype transplantation. ②108 patients (25.41%) developed HC, with the median time of onset of 32 (3-243) days and the median duration of 20 (3-93) days; 33 cases (30.56%) were grade Ⅰ, 49 cases of grade Ⅱ (45.36%) , 21 cases (19.44%) of grade Ⅲ, and 5 cases (4.63%) of grade Ⅳ. ③103 cases of HC were cured, 5 patients were ineffective, 12 patients died and died of transplantation related complications (infection, recurrence, severe acute GVHD, secondary implant failure) . ④Univariate analysis showed that age < 30, type of transplantation, CMV and acute GVHD were associated with the occurrence of HC after allo-HSCT. Multivariate analysis showed that acute GVHD was an independent risk factor for HC after allo-HSCT. Conclusion: Prognosis of HC after allo-HSCT was better after timely treatment.
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Affiliation(s)
- Q Wu
- Department of Hematology, PLA 960 Hospital, Jinan 250031, China
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15
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Aldiwani M, Tharakan T, Al-Hassani A, Gibbons N, Pavlu J, Hrouda D. BK Virus Associated Haemorrhagic Cystitis. A systematic review of current prevention and treatment strategies. Int J Surg 2019; 63:34-42. [PMID: 30711618 DOI: 10.1016/j.ijsu.2019.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/29/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND BK virus is a major cause of late onset haemorrhagic cystitis in patients undergoing Haematopoietic Cell Transplantation (HCT). The evidence for the management of BK Virus Associated Haemorrhagic Cystitis (BKV-HC) is limited. Much of the published data consists of non-randomised case series and case reports. To our knowledge this is the first systematic review for the management of BKV-HC in both paediatric and adult populations. Our primary outcome was to examine the evidence for strategies of 1) prevention and 2) cessation of haematuria associated with BKV. Secondary outcomes were to assess the toxicity of treatment strategies and devise management recommendations for clinicians. MATERIALS AND METHODS We performed a systematic review of the PubMed and Central databases to evaluate the current evidence. A search protocol was prepared and registered with the PROSPERO database (CRD42017082442). The review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. Results were classified by treatment type. Qualitative analysis of included articles was performed, and grades of recommendations were devised for each treatment. RESULTS Of 896 titles screened, 44 articles were included for qualitative analysis. The overall quality of evidence was low. There is insufficient evidence to recommend prophylactic quinolones. 40 studies evaluated treatments for established BKV-HC. There are no high-quality comparative studies. Cidofovir is the most studied treatment but quality of evidence is low, and grade of recommendation is weak. Hyperbaric oxygen therapy, Fibrin glue, Leflunomide, Sodium Pentosan Polysulfate, Intravesical Alum and Radiological embolisation have all been described but the effectiveness of these treatments is unclear. CONCLUSION There remains no clear specific treatment for BKV-HC. An effective multi-disciplinary approach leading to early recognition and initiation of treatment is encouraged. The development of novel therapies followed by well-designed clinical studies are urgently needed.
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Affiliation(s)
- M Aldiwani
- Dept of Urology, Imperial College NHS Trust, UK.
| | - T Tharakan
- Dept of Urology, Imperial College NHS Trust, UK
| | - A Al-Hassani
- Dept of Haematology, University College London, UK
| | - N Gibbons
- Dept of Urology, Imperial College NHS Trust, UK
| | - J Pavlu
- Centre for Haematology, Imperial College London, UK
| | - D Hrouda
- Dept of Urology, Imperial College NHS Trust, UK
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16
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Cesaro S, Dalianis T, Hanssen Rinaldo C, Koskenvuo M, Pegoraro A, Einsele H, Cordonnier C, Hirsch HH. ECIL guidelines for the prevention, diagnosis and treatment of BK polyomavirus-associated haemorrhagic cystitis in haematopoietic stem cell transplant recipients. J Antimicrob Chemother 2018; 73:12-21. [PMID: 29190347 DOI: 10.1093/jac/dkx324] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT. Methods Review of English literature and evidence-based recommendations by expert consensus. Results BKPyV-HC occurs in 8%-25% of paediatric and 7%-54% of adult recipients undergoing allogeneic HSCT. Diagnosis requires the triad of cystitis, macro-haematuria and high urine BKPyV loads >7 log10 copies/mL, and exclusion of other relevant aetiologies. BKPyV viraemia is frequent and may serve as a more specific semiquantitative follow-up marker. No randomized controlled trials are available to inform antiviral prophylaxis or treatment. However, hyper-hydration and/or bladder irrigation showed limited prophylactic value. Fluoroquinolones are not effective for prophylaxis or treatment, but rather increase antibiotic resistance. Hyperbaric oxygen or fibrin glue is marginally effective based on small case series from correspondingly equipped centres. Although cidofovir has been reported to improve and/or reduce BKPyV viraemia or viruria, the current data do not support its regular use. Conclusions BKPyV-HC remains a disabling unmet clinical need in HSCT that requires novel approaches supported by proper clinical trials.
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Affiliation(s)
- Simone Cesaro
- Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Tina Dalianis
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Christine Hanssen Rinaldo
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Minna Koskenvuo
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Anna Pegoraro
- Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Julius Maximilians University Würzburg, Germany
| | - Catherine Cordonnier
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Teaching Hospital, Department of Hematology, 94000 Créteil, Paris-Est Créteil (UPEC) University, Créteil
| | - Hans H Hirsch
- Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Petersplatz 10; CH-4009 Basel, Switzerland.,Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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17
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Geoghegan EM, Pastrana DV, Schowalter RM, Ray U, Gao W, Ho M, Pauly GT, Sigano DM, Kaynor C, Cahir-McFarland E, Combaluzier B, Grimm J, Buck CB. Infectious Entry and Neutralization of Pathogenic JC Polyomaviruses. Cell Rep 2018; 21:1169-1179. [PMID: 29091757 DOI: 10.1016/j.celrep.2017.10.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/08/2017] [Accepted: 10/06/2017] [Indexed: 12/24/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a lethal brain disease caused by uncontrolled replication of JC polyomavirus (JCV). JCV strains recovered from the brains of PML patients carry mutations that prevent the engagement of sialylated glycans, which are thought to serve as receptors for the infectious entry of wild-type JCV. In this report, we show that non-sialylated glycosaminoglycans (GAGs) can serve as alternative attachment receptors for the infectious entry of both wild-type and PML mutant JCV strains. After GAG-mediated attachment, PML mutant strains engage non-sialylated non-GAG co-receptor glycans, such as asialo-GM1. JCV-neutralizing monoclonal antibodies isolated from patients who recovered from PML appear to block infection by preventing the docking of post-attachment co-receptor glycans in an apical pocket of the JCV major capsid protein. Identification of the GAG-dependent/sialylated glycan-independent alternative entry pathway should facilitate the development of infection inhibitors, including recombinant neutralizing antibodies.
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Affiliation(s)
- Eileen M Geoghegan
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892-4263, USA
| | - Diana V Pastrana
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892-4263, USA
| | - Rachel M Schowalter
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892-4263, USA
| | - Upasana Ray
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892-4263, USA
| | - Wei Gao
- Antibody Therapy Section, Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Mitchell Ho
- Antibody Therapy Section, Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Gary T Pauly
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, 21702, USA
| | - Dina M Sigano
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, 21702, USA
| | | | | | | | - Jan Grimm
- Neurimmune Holding AG, Schlieren-Zurich, Switzerland
| | - Christopher B Buck
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892-4263, USA.
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18
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Yang L, Zha Y, Feng J, Dong H, Zong C, Lei X, Liang N, Wang X, Gao G, Bai X. Treatment of a Pediatric Case of Severe Hemorrhagic Cystitis: Case Report and Review of Literature. Transplant Proc 2017; 49:2365-2367. [PMID: 29198679 DOI: 10.1016/j.transproceed.2017.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/04/2017] [Indexed: 11/16/2022]
Abstract
Hemorrhagic cystitis is one of the complications of allogeneic hematopoietic stem cell transplantation. Treatment of hemorrhagic cystitis is difficult, especially in pediatric patients. A pediatric case of severe hemorrhagic cystitis after hematopoietic stem cell transplantation was treated in our hospital with arterial embolization combined with corticosteroid therapy because the conventional therapy was invalid for him. After the treatment, hemorrhagic cystitis was cured. During follow-up, the patient was in stable condition, with normal urine, blood cells returned to normal, bone marrow was in complete remission state, and disease-free survival for more than 8 months. Selective bladder arterial embolism followed by corticosteroid therapy successfully treated the patient.
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Affiliation(s)
- L Yang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Y Zha
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - J Feng
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - H Dong
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - C Zong
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - X Lei
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - N Liang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - X Wang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - G Gao
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - X Bai
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China.
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19
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Actinic cystitis: causes, treatment and experience of a single centre in the last five years. Urologia 2017; 85:25-28. [PMID: 29027183 DOI: 10.5301/uj.5000273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Actinic cystitis (AC) is the manifestation of symptoms and signs following pelvic radiotherapy. Pelvic radiotherapy produces both acute and chronic damage and such damage may have a devastating impact on the quality and on the amount of life of the patient. OBJECTIVES To evaluate the number of radical cystectomies that have become necessary in the last five years in our department for AC after radiation treatment. MATERIALS AND METHODS From February 2012 to February 2017, 11 patients underwent "open" cystectomy for AC. All patients were studied with radiographic examinations and endoscopy prior to surgery. We retrospectively evaluated the type of primitive cancer, the radiation dose administered, the time between radiation treatment and cystectomy. We also studied the related symptoms that required surgery. RESULTS The mean age of patients at the time of cystectomy was 75 years. In six patients (54.4%) radiotherapy was performed for prostate cancer, for rectal cancer in two patients (18.1%), and for endometrial cancer in three patients (27.2%). Total radiant dose was different in different patients depending on the type and localization of cancer. The median time between radiotherapy and cystectomy was 111 months (24-256 months). All patients had symptoms before surgery. Seven patients (63.3%) with gross haematuria were treated with endoscopic clot evacuation and fulguration. DISCUSSION The first approach to patients with AC is often supportive care. Surgery remains the most invasive treatment in the management of those patients who are not responsive to conservative treatments.
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20
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Au JK, Graziano C, Elizondo RA, Ryan S, Roth DR, Koh CJ, Gonzales ET, Tu DT, Janzen N, Naik S, Seth A. Urologic Outcomes of Children With Hemorrhagic Cystitis After Bone Marrow Transplant at a Single Institution. Urology 2016; 101:126-132. [PMID: 27793653 DOI: 10.1016/j.urology.2016.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyze clinical outcomes and the risk factors associated with genitourinary (GU) morbidity and mortality in children who present with hemorrhagic cystitis (HC) after bone marrow transplant (BMT). METHODS A retrospective chart review of patients with HC who had undergone BMT at a single pediatric hospital from 2008 to 2015 was conducted. Demographic data, severity of hematuria, HC management, and mortality were analyzed. Bivariate analysis and binary logistic regression were performed to identify risk factors. RESULTS Out of 43 patients who met inclusion criteria, 67.4% were male with a median age at BMT of 10.2 years (interquartile range 5.8-14.6). Percutaneous nephrostomy catheters were inserted in 5 patients for urinary diversion. All-cause mortality was 32.6% (N = 14). Intravesical retroviral therapy (P <.001), HC grade (P <.001), total Foley time (P <.001), total gross hematuria time (P <.001), total days hospitalized (P = .012), and days to most improved hematuria (P = .032) were associated with significant GU morbidity on bivariate analysis. On multivariable analysis, days to most improved hematuria was associated with significant GU morbidity odds ratio of 1.177 (1.006-1.376) (P = .042). Status of percutaneous nephrostomy was not associated with increased mortality (P = .472); however, in the multivariate model, BK viremia (P = .023), need for renal dialysis (P = .003), and presence of Foley catheter (P = .005) were associated with increased mortality. CONCLUSION Children with HC after BMT fall in a very high-risk category with high mortality and significant GU morbidity. The presence of a Foley catheter, need for dialysis, and BK viremia are associated with increased mortality.
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Affiliation(s)
- Jason K Au
- Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | | | - Rodolfo A Elizondo
- Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Sheila Ryan
- Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - David R Roth
- Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Chester J Koh
- Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Edmond T Gonzales
- Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Duong T Tu
- Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Nicolette Janzen
- Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Swati Naik
- Department of Hematology/Oncology, Texas Children's Hospital//Baylor College of Medicine, Houston, TX
| | - Abhishek Seth
- Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
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21
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Thompson A, Adamson A, Bahl A, Borwell J, Dodds D, Heath C, Huddart R, Mcmenemin R, Patel P, Peters J, Payne H. Guidelines for the diagnosis, prevention and management of chemical- and radiation-induced cystitis. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415813512647] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Haemorrhagic cystitis (HC) is a relatively common complication of chemotherapy and radiotherapy to the pelvic area, but can be a challenging condition to treat, particularly since there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed. Materials and methods A comprehensive literature search was undertaken to evaluate the evidence for the diagnosis, prevention and management of cancer treatment-induced HC. Results Recommendations and a proposed management algorithm for the diagnosis, prevention and treatment of HC, as well as the management of intractable haematuria, have been developed based on the expert opinion of the multidisciplinary consensus panel following a comprehensive review of the available clinical data. Conclusion These guidelines are relevant and applicable to current clinical practice and will help clinicians optimally define and manage this potentially serious condition.
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Affiliation(s)
- A Thompson
- Urology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, UK
| | - A Adamson
- Department of Urology, Royal Hampshire County Hospital, UK
| | - A Bahl
- Bristol Oncology and Haematology Centre, UK
| | - J Borwell
- Department of Urology, Frimley Park Hospital, UK
| | - D Dodds
- Beatson West of Scotland Cancer Care, UK
| | - C Heath
- Southampton Oncology Centre, Southampton General Hospital, UK
| | | | | | - P Patel
- Queen Elizabeth Hospital, UK
| | - J Peters
- Whipps Cross Hospital, Barts Health NHS Trust, UK
| | - H Payne
- University College Hospital, UK
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22
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Fidan K, Büyükkaragöz B, Özen O, Demirogullari B, Söylemezoglu O. The use of intravesical hyaluronic acid for recurrent urinary tract infections in children: a case-series study. Ren Fail 2015; 37:354-8. [PMID: 26375508 DOI: 10.3109/0886022x.2015.1087863] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This is the first study performed to evaluate the effects of intravesical hyaluronic acid (IHA) instillation on diminishing the frequency of recurrent urinary tract infections (UTIs) in children. METHODS Fifteen children (10 girls, 5 boys) with recurrent UTIs were divided into two groups as either complicated (group 1) (with accompanying disorders including vesicoureteral reflux or neurogenic bladder) or uncomplicated patients (group 2). After administration of weekly four sessions of IHA therapy the patients were followed-up monthly for 2 years and classified as responsive (complete/partial) or unresponsive to treatment. RESULTS 53.3% of the patients with recurrent UTIs were complicated. In group 1 (n = 8), complete and partial response rates were 62.5% (n = 5) and 25% (n = 2), respectively. There was no response in 12.5% (n = 1) of the cases in group 1. In group 2 (n = 7), complete and partial response rates were 71.4% (n = 5) and 14.3% (n = 1), respectively. In this group, 14.3% (n = 1) of the patients were found to be unresponsive to IHA treatment. No side effects were observed in any of the patients. CONCLUSIONS IHA administration is considered as an effective treatment modality which significantly reduces the prevalence of or even provides complete recovery from recurrent UTIs in childhood. Therefore, it is believed that this approach can be used as a promising alternative to widespread use of antibiotics in this patient group.
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Affiliation(s)
- Kibriya Fidan
- a Division of Pediatric Nephrology , Gazi University , Ankara , Turkey and
| | - Bahar Büyükkaragöz
- a Division of Pediatric Nephrology , Gazi University , Ankara , Turkey and
| | - Onur Özen
- b Division of Pediatric Surgery , Gazi University , Ankara , Turkey
| | | | - Oguz Söylemezoglu
- a Division of Pediatric Nephrology , Gazi University , Ankara , Turkey and
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23
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Lee SS, Ahn JS, Jung SH, Ahn SY, Kim JY, Jang HC, Kang SJ, Jang MO, Yang DH, Kim YK, Lee JJ, Kim HJ. Treatment of BK virus-associated hemorrhagic cystitis with low-dose intravenous cidofovir in patients undergoing allogeneic hematopoietic cell transplantation. Korean J Intern Med 2015; 30:212-8. [PMID: 25750563 PMCID: PMC4351328 DOI: 10.3904/kjim.2015.30.2.212] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/22/2014] [Accepted: 07/07/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS BK virus (BKV) has been associated with late-onset hemorrhagic cystitis (HC) in recipients of hematopoietic stem cell transplantation (HSCT). Cidofovir has been used at higher doses (3 to 5 mg/kg/wk) with probenecid prophylaxis; however, cidofovir may result in nephrotoxicity or cytopenia at high doses. METHODS Allogeneic HSCT recipients with BKV-associated HC are treated with 1 mg/kg intravenous cidofovir weekly at our institution. A microbiological response was defined as at least a one log reduction in urinary BKV viral load, and a clinical response was defined as improvement in symptoms and stability or reduction in cystitis grade. RESULTS Eight patients received a median of 4 weekly (range, 2 to 11) doses of cidofovir. HC occurred a median 69 days (range, 16 to 311) after allogeneic HSCT. A clinical response was detected in 7/8 patients (86%), and 4/5 (80%) had a measurable microbiological response. One patient died of uncontrolled graft-versus-host disease; therefore, we could not measure the clinical response to HC treatment. One microbiological non-responder had a stable BKV viral load with clinical improvement. Only three patients showed transient grade 2 serum creatinine toxicities, which resolved after completion of concomitant calcineurin inhibitor treatment. CONCLUSIONS Weekly intravenous low-dose cidofovir without probenecid appears to be a safe and effective treatment option for patients with BKV-associated HC.
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Affiliation(s)
- Seung-Shin Lee
- Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jae-Sook Ahn
- Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Sung-Hoon Jung
- Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Seo-Yeon Ahn
- Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jae-Yong Kim
- Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hee-Chang Jang
- Department of Infectious Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Seung-Ji Kang
- Department of Infectious Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Mi-Ok Jang
- Department of Infectious Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Deok-Hwan Yang
- Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yeo-Kyeoung Kim
- Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Je-Jung Lee
- Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyeoung-Joon Kim
- Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
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24
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Han SB, Cho B, Kang JH. BK virus-associated hemorrhagic cystitis after pediatric stem cell transplantation. KOREAN JOURNAL OF PEDIATRICS 2014; 57:514-9. [PMID: 25653684 PMCID: PMC4316594 DOI: 10.3345/kjp.2014.57.12.514] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/08/2014] [Indexed: 02/08/2023]
Abstract
Hemorrhagic cystitis is a common stem cell transplantation-related complication. The incidence of early-onset hemorrhagic cystitis, which is related to the pretransplant conditioning regimen, has decreased with the concomitant use of mesna and hyperhydration. However, late-onset hemorrhagic cystitis, which is usually caused by the BK virus, continues to develop. Although the BK virus is the most common pathogenic microorganism of poststem cell transplantation late-onset hemorrhagic cystitis, pediatricians outside the hemato-oncology and nephrology specialties tend to be unfamiliar with hemorrhagic cystitis and the BK virus. Moreover, no standard guidelines for the early diagnosis and treatment of BK virus-associated hemorrhagic cystitis after stem cell transplantation have been established. Here, we briefly introduce poststem cell transplantation BK virus-associated hemorrhagic cystitis.
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Affiliation(s)
- Seung Beom Han
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea. ; The Vaccine Bio Research Institute, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Bin Cho
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea. ; The Catholic Blood and Marrow Transplantation Center, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Han Kang
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea. ; The Vaccine Bio Research Institute, The Catholic University of Korea College of Medicine, Seoul, Korea
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Tsai CJ, Wang SS, Ou YC. Cyclophosphamide-induced intractable hemorrhagic cystitis treated with hyperbaric oxygenation and intravesical sodium hyaluronate. UROLOGICAL SCIENCE 2014. [DOI: 10.1016/j.urols.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Tirindelli MC, Flammia GP, Bove P, Cerretti R, Cudillo L, De Angelis G, Picardi A, Annibali O, Nobile C, Cerchiara E, Dentamaro T, De Fabritiis P, Lanti A, Ferraro AS, Sergi F, Di Piazza F, Avvisati G, Arcese W. Fibrin Glue Therapy for Severe Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2014; 20:1612-7. [DOI: 10.1016/j.bbmt.2014.06.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/13/2014] [Indexed: 11/15/2022]
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Sommariva M, Lazzeri M, Abrate A, Guazzoni G, Sandri S, Montorsi F. Intravesical Hyaluronic Acid and Chondroitin Sulphate Improve Symptoms and Quality of Life in Patients with Late Radiation Tissue Cystitis: An Investigative Pilot Study. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intravesical hyaluronic acid (HA) and chondroitin sulphate (CS) instillation are effective for urinary tract infections (UTIs) and bladder pain syndrome. This study aimed to evaluate the tolerability, safety and efficacy of intravesical HA and CS instillation in patients with late radiation tissue cystitis (LRTC). In this pilot study, tolerability was reported as discontinuation or deviation of the protocol, safety as general or local side effects, efficacy as improvement of bladder capacity and frequency, quality of life (QoL) through the European Quality of Life 5-Dimensions (EQ-5D) (details at http://www.controlled-trials.com/ISRCTN37534393 ). Thirty-two patients with LRTC were enrolled. Twenty-seven patients (84.8%) received a mean of 12.2±0.3 months of instillation therapy. Only two patients (6.2%) developed a urinary tract infection from instillation, which required antibiotic treatment, nevertheless not compromising the therapy schedule. No male patient developed a urethral stricture. Intravesical instillation was associated with a significant increase (>50%) of bladder capacity from baseline (66.9ml) both at 3 months (101.9ml; p<0.001) and 12 months (174.4 ml; p<0.001). EQ-5D index significantly increased from baseline to both 3 and 12 months (0.26, 0.69 and 0.96, respectively; p<0.001). Intravesical co-administration of HA and CS improved bladder function, symptoms and QoL in patients with LRTC.
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Affiliation(s)
- M.L. Sommariva
- Department of Urology, G. Fornaroli Hospital, Magenta, Milan, Italy
| | - M. Lazzeri
- Department of Urology, Ospedale San Raffaele, San Raffaele Scientific Institute, Milan, Italy
| | - A. Abrate
- Department of Urology, Ospedale San Raffaele, San Raffaele Scientific Institute, Milan, Italy
| | - G. Guazzoni
- Department of Urology, Ospedale San Raffaele, San Raffaele Scientific Institute, Milan, Italy
| | - S. Sandri
- Department of Urology, G. Fornaroli Hospital, Magenta, Milan, Italy
| | - F. Montorsi
- Department of Urology, Ospedale San Raffaele, San Raffaele Scientific Institute, Milan, Italy
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Payne H, Adamson A, Bahl A, Borwell J, Dodds D, Heath C, Huddart R, McMenemin R, Patel P, Peters JL, Thompson A. Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges. BJU Int 2013; 112:885-97. [PMID: 24000900 PMCID: PMC4155867 DOI: 10.1111/bju.12291] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 11/30/2022]
Abstract
To review the published data on predisposing risk factors for cancer treatment-induced haemorrhagic cystitis (HC) and the evidence for the different preventive and therapeutic measures that have been used in order to help clinicians optimally define and manage this potentially serious condition. Despite recognition that HC can be a significant complication of cancer treatment, there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed. A systematic literature review was undertaken to evaluate the evidence for preventative measures and treatment options in the management of cancer treatment-induced HC. There is a wide range of reported incidence due to several factors including variability in study design and quality, the type of causal agent, the grading of bleeding, and discrepancies in definition criteria. The most frequently reported causal factors are radiotherapy to the pelvic area, where HC has been reported in up to 20% of patients, and treatment with cyclophosphamide and bacillus Calmette-Guérin, where the incidence has been reported as up to 30%. Mesna (2-mercaptoethane sodium sulphonate), hyperhydration and bladder irrigation have been the most frequently used prophylactic measures to prevent treatment-related cystitis, but are not always effective. Cranberry juice is widely cited as a preventative measure and sodium pentosanpolysulphate as a treatment, although the evidence for both is very limited. The best evidence exists for intravesical hyaluronic acid as an effective preventative and active treatment, and for hyperbaric oxygen as an equally effective treatment option. The lack of robust data and variability in treatment strategies used highlights the need for further research, as well as best practice guidance and consensus on the management of HC.
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Affiliation(s)
| | | | - Amit Bahl
- Bristol Oncology and Haematology CentreBristol, UK
| | | | - David Dodds
- Beatson West of Scotland Cancer CareGlasgow, UK
| | | | | | | | | | - John L Peters
- Whipps Cross Hospital, Barts Health NHS TrustLondon, UK
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BK Virus Associated Late Onset Haemorrhagic Cystitis After Allogeneic Peripheral Blood Stem Cell Transplant. Indian J Hematol Blood Transfus 2012; 27:177-9. [PMID: 22942570 DOI: 10.1007/s12288-011-0082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022] Open
Abstract
Haemorrhagic cystitis (HC) after allogeneic stem cell transplant is a clinical disorder with multiple etiologies. There is an inflammation of the bladder mucosa leading to painful haematuria. Early onset HC is mainly attributed to conditioning chemotherapy consisting of cyclophosphamide. Late onset HC is now being related to reactivation of latent polyoma BK virus (BKV). We describe the case of a 37 year old male with acute myeloid leukemia presenting with haematuria after allogeneic stem cell transplant.
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Madersbacher H, van Ophoven A, van Kerrebroeck PEVA. GAG layer replenishment therapy for chronic forms of cystitis with intravesical glycosaminoglycans--a review. Neurourol Urodyn 2012; 32:9-18. [PMID: 22782909 DOI: 10.1002/nau.22256] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 03/13/2012] [Indexed: 11/07/2022]
Abstract
AIMS Glycosaminoglycan (GAG) layer replenishment is a cornerstone in the therapy of interstitial cystitis (IC). During the last years intravesical GAG layer replenishment has proven to be an effective treatment for overactive bladder (OAB), radiation cystitis, and recurrent urinary tract infections (UTIs). METHODS Examination of different substances available for intravesical GAG replenishment and evaluation of the evidence for the treatment of the above-mentioned conditions. RESULTS We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE) database for studies on intravesical GAG replenishment. A total of 27 clinical studies remain relevant to this topic, many of them with mixed patient selection and suboptimal definition of symptom improvement/success. Two placebo controlled studies with hyaluronic acid failed to show superiority and have not been published. One active controlled randomized study has been published showing that chondroitin sulphate 0.2% has a clear benefit for OAB patients. Another study with chondroitin sulphate 2.0% failed to show statistically significant evidence, but was underpowered. CONCLUSIONS A short number of randomized controlled studies confirm efficacy of intravesical GAG layer replenishment therapy. Concluded from the study background (which comprises also uncontrolled studies), so far chondroitin sulphate 0.2% is in favor for intravesical GAG layer replenishment therapy. In general, large-scale trials are urgently needed to underline the benefit of this type of therapy.
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Mackey MC. Intravesicular cidofovir for the treatment of polyomavirus-associated hemorrhagic cystitis. Ann Pharmacother 2012; 46:442-6. [PMID: 22395246 DOI: 10.1345/aph.1q430] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To review the literature regarding the use of intravesicular cidofovir in the treatment of polyomavirus-associated hemorrhagic cystitis. DATA SOURCES Searches of PubMed were conducted, with key search terms including intravesicular cidofovir, polyomavirus, BK virus, JC virus, and hemorrhagic cystitis. Limits were set to include human subjects. STUDY SELECTION AND DATA EXTRACTION All articles identified were evaluated, and one was excluded due to being published only in the German language. All case studies/case series were included if patients received at least 1 dose of intravesicular cidofovir for treatment of cystitis. DATA SYNTHESIS Polyomavirus-associated hemorrhagic cystitis is more common in immunocompromised patients, particularly those who have undergone stem cell transplantation. Early-onset cystitis is often due to chemotherapy agents, while cystitis that develops 10-14 days into therapy is often associated with infection with polyomavirus, such as BK virus. There is no standard of therapy for polyomavirus-associated cystitis other than hyperhydration and continuous bladder irrigation, and many different therapeutic agents have been used in this setting, with mixed results. One such agent, intravenous cidofovir, provides clinical improvement but carries a risk of renal failure. Intravesicular cidofovir has been reported in case reports/series to provide positive symptomatic improvement; however, it has not been universally found to decrease urine viral load. CONCLUSIONS At this time, it appears that intravesicular cidofovir may be used as an option to provide symptomatic relief in patients with polyomavirus-associated hemorrhagic cystitis. However, it is not definitively known whether its use significantly decreases urine virus load in these patients. Larger clinical trials need to be conducted to fully understand the role of intravesicular cidofovir in this setting.
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Affiliation(s)
- Melissa C Mackey
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA.
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Guven S, Laguna MP, Kilinc M, de la Rosette JJ. Intractable Bladder Hemorrhage: Providing a Treatment Algorithm for a Complex Clinical Problem. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0106-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Savva-Bordalo J, Pinho Vaz C, Sousa M, Branca R, Campilho F, Resende R, Baldaque I, Camacho O, Campos A. Clinical effectiveness of hyperbaric oxygen therapy for BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation. Bone Marrow Transplant 2011; 47:1095-8. [PMID: 22080970 DOI: 10.1038/bmt.2011.228] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Late-onset hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT) has been associated with BK virus (BKV). Antiviral drugs are of limited efficacy and the optimal treatment for HC has not yet been established. Hyperbaric oxygen (HBO) may benefit these patients. We, therefore, retrospectively evaluated the effectiveness of HBO therapy in 16 patients with HC after allogeneic HSCT. All 16 patients had macroscopic hematuria and BKV infection. Patients received 100% oxygen in a hyperbaric chamber at 2.1 atmospheres for 90 min, 5 days per week, with a median 13 treatments (range, 4-84). Fifteen patients (94%) showed complete resolution of hematuria. Median urinary DNA BKV titers declined after HBO (P<0.05). Patients started on HBO earlier after diagnosis of HC responded sooner (P<0.05). HBO was generally well tolerated and proved to be a reliable option for this difficult to manage condition.
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Affiliation(s)
- J Savva-Bordalo
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute, Porto, Portugal.
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Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int 2011; 109:691-4. [PMID: 21895939 DOI: 10.1111/j.1464-410x.2011.10550.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE • To compare the efficacy of intravesical hyaluronic acid (HA) instillation and hyperbaric oxygen (HBO) in the treatment of radiation-induced haemorrhagic cystitis (HC). PATIENTS AND METHODS • In total 36 patients who underwent radiotherapy for their pelvic malignancies and subsequently suffered from HC were randomly divided into an HA group and an HBO group. • Symptoms of haematuria, frequency of voiding and the visual analogue scale of pelvic pain (range 0-10) were evaluated before and after the treatment with follow-up of 18 months. RESULTS • All patients completed this study and no obvious side effects of intravesical HA were recorded. • The improvement rate showed no statistical difference between the two groups at 6, 12 and 18 months after treatment. • Decrease of frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy. • The improvement in the visual analogue scale remained significant in both groups for 18 months. CONCLUSIONS • Intravesical instillation of HA was as effective in treating radiation-induced HC as HBO. • It is well tolerated and resulted in a sustained decrease of bladder bleeding, pelvic pain and frequency of voiding for at least 12 months.
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Affiliation(s)
- Yuan Shao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Abstract
Severe hemorrhagic cystitis often arises from anticancer chemotherapy or radiotherapy for pelvic malignancies. Infectious etiologies are less common causes except in immunocompromised hosts. These cases can be challenging problems for the urologist and a source of substantial morbidity and sometimes mortality for the patients. A variety of modalities of treatment have been described for the management of hemorrhagic cystitis but there is none that is uniformly effective. Some progress has been made in the understanding and management of viral hemorrhagic cystitis. This article reviews the common causes of severe hemorrhagic cystitis and the currently available management options.
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Affiliation(s)
- R Manikandan
- Department of Urology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry - 605 006, India
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Hassan Z. Management of refractory hemorrhagic cystitis following hematopoietic stem cell transplantation in children. Pediatr Transplant 2011; 15:348-61. [PMID: 21504524 DOI: 10.1111/j.1399-3046.2011.01505.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HC is a complication associated with HSCT, but occurs rarely in solid organ recipients. The reported incidence varies from <10% to more than 70%. HC is characterized by hemorrhagic inflammation in urinary tract mucosa with symptoms varying from asymptomatic microscopic hematuria to frank hematuria with clot formation and urinary tract obstruction. Early onset HC may be explained by toxicity of chemo- and/or radiotherapy, while multiple factors including viral infections and their interplay seem to be involved in late onset HC. So far, only incidence of cyclophosphamide-associated HC has been reduced with preventive treatment. Likely, once HC is established, the treatment principles are similar regardless of the etiology and depend on the intensity of HC. Prevention of urinary tract obstruction, transfusion support, analgesic, and spasmolytic therapy are generally accepted in HC management. Treatment beyond this conservative approach entails higher risk for side effects, and thus treatment escalation proportional to HC intensity is warranted. No standard and evidence-based treatment escalation algorithm has been widely adopted yet. As severe HC following HSCT is a potentially life-threatening complication, a multidisciplinary and individual approach is required in children suffering from this devastating complication.
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Affiliation(s)
- Zuzana Hassan
- Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Cipe FE, Soygür T, Doğu F, Erdoğan O, Bozdoğan G, Ikincioğullari A. Late onset hemorrhagic cystitis in a hematopoietic stem cell recipient: treatment with intravesical hyaluronic acid. Pediatr Transplant 2010; 14:E79-82. [PMID: 19344339 DOI: 10.1111/j.1399-3046.2009.01169.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HC is a common complication following HSCT. Risk factors include viral infections, cyclophosphamide and busulfan usage, pelvic irradiation, older age at transplantation, allogeneic HSCT and GvHD. The severity of HC ranges from mild hematuria to life-threatening bleeding. Here, we present a seven-and-a-half-yr-old boy with Wiskott-Aldrich syndrome who experienced a late onset Grade III hemorrhagic cystitis following HSCT from his fully matched sibling. A Grade I GvHD localized to skin developed on day +11 and prednisolone therapy was given between the 11th and 22nd d. Myeloid and platelet engraftments were achieved +13 and +16 d, respectively. A gross hematuria began on the 21st post-transplant day. The urine cultures for bacterial or fungal organisms were negative. Urine analysis by PCR revealed a CMV viruria. Following systemic ganciclovir treatment, urinary CMV became negative but hemorrhagic cystitis did not improve. Due to the probability of existing BK virus or adenovirus, two doses of cidofovir were administered intravesically. As he continued to have painful hematuria with large clot formations, two doses of intravesical hyaluronic acid were applied. Macroscopic hematuria resolved within four d after the second dose. Complete remission was achieved on day +77. Finally, intravesical administration of hyaluronic acid seems to be effective and safe and can be a promising treatment in patients suffering from severe and late onset HC.
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Affiliation(s)
- Funda Erol Cipe
- Department of Pediatric Immunology-Allergy, Ankara University, School of Medicine, Ankara, Turkey
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Decker DB, Karam JA, Wilcox DT. Pediatric hemorrhagic cystitis. J Pediatr Urol 2009; 5:254-64. [PMID: 19303365 DOI: 10.1016/j.jpurol.2009.02.199] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 02/13/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the current literature as it pertains to hemorrhagic cystitis (HC) in the pediatric bone-marrow transplant (BMT) population. By reviewing the pathophysiology of the disease, preventive methods, and therapeutic options, urologists may be better equipped to manage this challenging clinical scenario. MATERIALS AND METHODS The HC literature was reviewed using a MEDLINE/PubMed literature search, specifically focusing on the pediatric BMT population as it pertains to the incidence, pathophysiology, prevention, and treatment of HC. RESULTS Conservative estimates of HC incidence in recent retrospective studies of pediatric BMT populations still approach 10-20%. Several high-volume pediatric BMT centers have reported contemporary data on their experience with HC providing increased insight into incidence and pathophysiology. Accumulating evidence linking BK virus to HC is a significant development warranting further investigation. Other contributing agents/risk factors need identification in the likely multifactorial etiology of HC. Preventive and therapeutic strategies have made modest advances, but certainly need further validation with prospective randomized studies. CONCLUSIONS Pediatric BMT patients are susceptible for HC development despite preventive measures and improved insight into the pathophysiology. Unfortunately, there are no evidence-based treatment guidelines for this difficult clinical issue that frequently requires prolonged care and multiple treatment modalities necessitating judicious patience in the application of more aggressive interventions.
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Affiliation(s)
- Daniel B Decker
- Children's Medical Center at Dallas, University of Texas Southwestern Medical Center, Department of Urology, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA.
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Hyperbaric oxygen therapy in BKV-associated hemorrhagic cystitis refractory to intravenous and intravesical cidofovir: Case report and review of literature. Leuk Res 2009; 33:556-60. [DOI: 10.1016/j.leukres.2008.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 06/16/2008] [Accepted: 06/17/2008] [Indexed: 11/22/2022]
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Tirindelli MC, Flammia G, Sergi F, Cerretti R, Cudillo L, Picardi A, Postorino M, Annibali O, Greco R, Avvisati G, Arcese W. Fibrin glue for refractory hemorrhagic cystitis after unrelated marrow, cord blood, and haploidentical hematopoietic stem cell transplantation. Transfusion 2009; 49:170-5. [DOI: 10.1111/j.1537-2995.2008.01934.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Harkensee C, Vasdev N, Gennery AR, Willetts IE, Taylor C. 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 Haematol 2008; 142:717-31. [PMID: 18540939 DOI: 10.1111/j.1365-2141.2008.07254.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Haemorrhagic cystitis (HC) is a common and, in its severe form, potentially life-threatening complication of Haematopoietic stem cell transplantation (HSCT) in children. Recent data indicate an important role of BK virus reactivation during the time of maximal post-transplant immune suppression in the pathogenesis of late-onset HC. Treatment of HC is mainly symptomatic and often frustrating. To give clinicians guidance on prevention and treatment options and their backing by scientific evidence, we have systematically assessed the available literature and devised evidence-based guidelines. Our comprehensive review demonstrates that evidence for the most commonly used interventions (such as cidofovir, oestrogen, hyperbaric oxygen, bladder instillation with formalin, alum salts or prostaglandin) is very limited. Some of these interventions also carry significant risks. Higher level evidence exists only for 2-mercaptoethane sodium (MESNA) and hyperhydration as a preventative intervention, and for systemic recombinant Factor VII as a treatment to stop acute haemorrhage. Further high-quality studies are required to establish effective and safe prevention and treatment options for HC.
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Affiliation(s)
- Christian Harkensee
- Supra-regional Children's Bone Marrow Transplant Unit (CBMTU), Newcastle General Hospital, Newcastle upon Tyne, UK.
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González-Vicent M, Lassaletta A, López-Pino MA, Romero-Tejada JC, de la Fuente-Trabado M, Díaz MA. Aspergillus "fungus ball" of the bladder after hematopoietic transplantation in a pediatric patient: successful treatment with intravesical voriconazole and surgery. Pediatr Transplant 2008; 12:242-5. [PMID: 18266800 DOI: 10.1111/j.1399-3046.2007.00871.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aspergillosis is an important cause of mortality in allogeneic HSCT. A "fungus ball" formation of Aspergillus in the bladder has seldom been reported. We report a child that underwent HSCT and developed possible disseminated aspergillosis with an intravesical "fungus ball," diagnosed by genitourinary MRI and PCR of the mass that was removed from the bladder. It is important to consider this complication in a patient with HC after HSCT. The treatment included a combination of systemic antifungal therapy along with intravesical voriconazole and surgical removal.
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Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT. Bone Marrow Transplant 2008; 41:881-6. [DOI: 10.1038/bmt.2008.4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Iavazzo C, Athanasiou S, Pitsouni E, Falagas ME. Hyaluronic Acid: An Effective Alternative Treatment of Interstitial Cystitis, Recurrent Urinary Tract Infections, and Hemorrhagic Cystitis? Eur Urol 2007; 51:1534-40; discussion 1540-1. [PMID: 17383810 DOI: 10.1016/j.eururo.2007.03.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 03/09/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Hyaluronic acid is a protective barrier of the urothelium. A damaged glycosaminoglycan layer may increase the possibility of bacterial adherence and infection. This damage is proposed to be a causative factor in the development of interstitial cystitis, common urinary tract infections, and hemorrhagic cystitis due to posthematopoietic stem cell transplantation. The aim of this article was to review the available data regarding the use of hyaluronic acid as an alternative treatment of the above-mentioned conditions. METHODS Articles relevant to our review that were archived by September 2006 were retrieved from PubMed. RESULTS Nine relevant studies were identified and evaluated. Hyaluronic acid was administered intravesically at a dose of 40 mg every week for 4-6 wk; patients with noted improvement received two additional monthly doses. Short-term responses of patients with interstitial cystitis, hemorrhagic cystitis, and recurrent urinary tract infections were 30-73% (7 studies), 71% (1 study), and 100% (1 study), respectively. The treatment was well tolerated except for occasional development of bacterial cystitis. The cost of each intravesical installation of hyaluronic acid is 120 UK pounds (excluding the cost of the urinary catheterization). CONCLUSIONS The available clinical data regarding the effectiveness of hyaluronic acid as a potential treatment of patients with interstitial cystitis, recurrent urinary tract infections, and hemorrhagic cystitis are limited. There is need for randomized controlled trials for further investigation of this important therapeutics question; these clinical trials should be disease-specific, blinded, and controlled, and of a sufficient number of patients. Until such studies are available, intravesical instillation of hyaluronic acid cannot be unquestionably endorsed for use for the aforementioned diseases.
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