Hadjibabaie Molouk, Alimoghaddam Kamran, Shamshiri Ahmad Reza, Iravani Masoud, Bahar Babak, Mousavi Asadollah, Jahani Mohammad, Khodabandeh Ali, Anvari Yasha, Gholami Kheirollah, Ghavamzadeh Ardeshir
Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Urol Oncol. 2008 Jan-Feb;26(1):43-6. doi: 10.1016/j.urolonc.2006.12.015. Epub 2007 Nov 7.
Hemorrhagic cystitis is 1 of the most troublesome complications of hematopoietic cell transplantation conditioning regimens. We conducted a nonrandomized controlled clinical study to investigate the role of continuous bladder irrigation in addition to mesna, hydration, and alkalization in the prevention of hemorrhagic cystitis after allogeneic hematopoietic cell transplantation. A total of 80 eligible patients entered the study. From May 2006, 40 patients who underwent allogeneic hematopoietic cell transplantation received continuous bladder irrigation in addition to the common protocol. A historical control group of 40 consecutive patients with same inclusion criteria who did not receive bladder irrigation was enrolled from before May 2006. Hemorrhagic cystitis occurred in 50% of patients in the no bladder irrigation group versus 32% in bladder irrigation group (P = 0.11). The mean duration of hemorrhagic cystitis was significantly reduced in the bladder irrigation group (10 vs. 18 days; P = 0.02). Duration of hospitalization was significantly shorter in the bladder irrigation group (30.2 vs. 39.6; P < 0.001). Late-onset hemorrhagic cystitis that occurred beyond 4 weeks after allo-hemorrhagic cystitis happened more significantly in the no bladder irrigation group (P = 0.001). High-grade hemorrhagic cystitis was more frequently associated with high-grade graft-versus-host disease within 30 days after transplant (P = 0.06). In general, continuous bladder irrigation added to mesna, hydration, and alkalization regimens was well tolerated, decreased the complications of hemorrhagic cystitis, and may be useful in hematopoietic cell transplantation patients. However, more investigations with randomized controlled clinical trials with more patients are needed.
出血性膀胱炎是造血细胞移植预处理方案中最麻烦的并发症之一。我们进行了一项非随机对照临床研究，以调查在美司钠、水化和碱化基础上持续膀胱冲洗在预防异基因造血细胞移植后出血性膀胱炎中的作用。共有80例符合条件的患者进入研究。从2006年5月起，40例接受异基因造血细胞移植的患者除采用常规方案外还接受了持续膀胱冲洗。从2006年5月之前连续纳入40例具有相同纳入标准但未接受膀胱冲洗的患者作为历史对照组。未进行膀胱冲洗组50%的患者发生了出血性膀胱炎，而膀胱冲洗组为32%（P = 0.11）。膀胱冲洗组出血性膀胱炎的平均持续时间显著缩短（10天对18天；P = 0.02）。膀胱冲洗组的住院时间显著缩短（30.2天对39.6天；P < 0.001）。异基因造血细胞移植后4周后发生的迟发性出血性膀胱炎在未进行膀胱冲洗组中更为显著（P = 0.001）。移植后30天内，重度出血性膀胱炎更常与重度移植物抗宿主病相关（P = 0.06）。总体而言，在美司钠、水化和碱化方案基础上加用持续膀胱冲洗耐受性良好，减少了出血性膀胱炎的并发症，可能对造血细胞移植患者有用。然而，需要更多患者参与的随机对照临床试验进行更多研究。
