Decker Daniel B, Karam Jose A, Wilcox Duncan T
Children's Medical Center at Dallas, University of Texas Southwestern Medical Center, Department of Urology, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA.
J Pediatr Urol. 2009 Aug;5(4):254-64. doi: 10.1016/j.jpurol.2009.02.199. Epub 2009 Mar 19.
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.
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.
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.
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.
回顾当前与儿科骨髓移植（BMT）人群出血性膀胱炎（HC）相关的文献。通过回顾该疾病的病理生理学、预防方法和治疗选择，泌尿科医生或许能更好地应对这一具有挑战性的临床情况。
使用MEDLINE/PubMed文献检索对HC相关文献进行回顾，特别关注儿科BMT人群中HC的发病率、病理生理学、预防和治疗。
近期儿科BMT人群回顾性研究中对HC发病率的保守估计仍接近10%-20%。几个大规模儿科BMT中心报告了其HC治疗经验的当代数据，这为发病率和病理生理学提供了更多见解。将BK病毒与HC联系起来的证据不断积累，这是一个重大进展，值得进一步研究。在可能的HC多因素病因中，其他致病因素/风险因素有待确定。预防和治疗策略虽有一定进展，但肯定需要前瞻性随机研究进一步验证。
尽管采取了预防措施且对病理生理学有了更深入了解，但儿科BMT患者仍易发生HC。不幸的是，对于这个困难的临床问题，尚无基于证据的治疗指南，该问题常常需要长期护理和多种治疗方式，在应用更积极的干预措施时需要审慎耐心。
