Division of Urology, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota, USA.
J Urol. 2012 Jul;188(1):242-6. doi: 10.1016/j.juro.2012.03.020. Epub 2012 May 15.
Severe hemorrhagic cystitis is a major complication in the pediatric population undergoing hematopoietic stem cell transplantation. Percutaneous nephrostomy tube drainage as a treatment for severe hemorrhagic cystitis has rarely been investigated. We examined children undergoing hematopoietic stem cell transplantation for risk factors associated with severe hemorrhagic cystitis, as well as our experience with percutaneous nephrostomy tube placement as an adjunctive management strategy.
Using prospectively collected data from the Blood and Marrow Transplant Database at the University of Minnesota, we reviewed 40 pediatric patients with severe hemorrhagic cystitis from 1996 to 2010. Specific treatment for each patient was administered at the discretion of the attending physician and generally included bladder irrigation before bladder fulguration or percutaneous nephrostomy tube placement. A percutaneous nephrostomy tube was placed in 11 patients due to the intractable nature of the hemorrhagic cystitis.
Of the 11 patients who underwent percutaneous nephrostomy tube drainage 5 (45%) had improvement of the hemorrhagic cystitis within 30 days and the same number had long-term resolution. Among the patients with long-term resolution hemorrhagic cystitis resolved an average of 12.4 days after percutaneous nephrostomy tube placement, and the tubes were removed an average of 8.8 weeks after placement. Through September 2011 mortality among patients with percutaneous nephrostomy tubes was 55% (6 of 11 patients), which was identical to the overall mortality in the severe hemorrhagic cystitis group (22 of 40). No death could be directly attributed to hemorrhagic cystitis or percutaneous nephrostomy tube placement.
Placement of percutaneous nephrostomy tubes for treatment of severe hemorrhagic cystitis results in long-term improvement in intractable hemorrhagic cystitis, and is a safe and viable option for the majority of patients.
严重出血性膀胱炎是儿童造血干细胞移植后发生的主要并发症。经皮肾造瘘管引流作为治疗严重出血性膀胱炎的方法很少被研究。我们检查了接受造血干细胞移植的儿童，以确定与严重出血性膀胱炎相关的危险因素，以及我们在经皮肾造瘘管放置方面的经验，作为辅助管理策略。
使用明尼苏达大学血液和骨髓移植数据库前瞻性收集的数据，我们回顾了 1996 年至 2010 年间 40 名患有严重出血性膀胱炎的儿科患者。每位患者的具体治疗方案由主治医生决定，通常包括膀胱灌洗后再进行膀胱电灼或经皮肾造瘘管放置。由于出血性膀胱炎的顽固性质，11 名患者接受了经皮肾造瘘管引流。
在接受经皮肾造瘘管引流的 11 名患者中，5 名（45%）在 30 天内出血性膀胱炎得到改善，同样数量的患者长期缓解。在长期缓解的患者中，出血性膀胱炎在经皮肾造瘘管放置后平均 12.4 天得到缓解，造瘘管平均在放置后 8.8 周被移除。截至 2011 年 9 月，接受经皮肾造瘘管治疗的患者死亡率为 55%（11 名患者中的 6 名），与严重出血性膀胱炎组的总体死亡率（40 名患者中的 22 名）相同。没有死亡可以直接归因于出血性膀胱炎或经皮肾造瘘管放置。
经皮肾造瘘管治疗严重出血性膀胱炎可长期改善难治性出血性膀胱炎，是大多数患者安全可行的选择。
