Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
J Urol. 2014 Dec;192(6):1687-92. doi: 10.1016/j.juro.2014.06.030. Epub 2014 Jun 14.
We evaluate the clinical presentation, management and outcomes of patients undergoing cystectomy for refractory hemorrhagic cystitis.
We identified 21 patients with refractory hematuria treated with cystectomy at our institution between 2000 and 2012. Clot evacuation, bladder fulguration and bladder irrigation had failed in all patients before cystectomy. In addition, 45% of patients had received prior intravesical therapy (aminocaproic acid, alum or formalin), hyperbaric oxygen therapy (25%), nephrostomy tube placement for attempted urinary diversion (15%) and/or selective bladder angioembolization (5%).
Median patient age at surgery was 77 years (IQR 72, 80) and 81% (17 of 21) of patients were male. The most common etiology for hemorrhagic cystitis was prior radiation therapy for prostate cancer (17, 81%). Median time from receipt of radiation to cystectomy in these patients was 91 months (IQR 73, 125). Median ASA® (American Society of Anesthesiologists) score at cystectomy was 3 and median preoperative hemoglobin was 10.2 gm/dl. Median length of stay after cystectomy was 10 days (IQR 7, 19). Severe (Clavien grade III to V) complications were noted in 42% of patients (8 of 19) and the 90-day mortality rate in this cohort was 16% (3 of 19). With a median postoperative followup of 13 months (IQR 4, 21), the 1 and 3-year overall survival was 84% and 52%, respectively.
Cystectomy for hemorrhagic cystitis is associated with a high risk of perioperative complications and mortality, consistent with the baseline clinical status of this patient cohort and, as such, should remain a last resort to control bleeding after failure of conservative measures.
评估行膀胱切除术治疗难治性出血性膀胱炎患者的临床表现、治疗方法和结局。
我们在本机构 2000 年至 2012 年间，共发现 21 例难治性血尿患者接受了膀胱切除术。在进行膀胱切除术前，所有患者的膀胱冲洗、膀胱灼烙术和血块清除术均已失败。此外，45%的患者曾接受过膀胱内治疗（氨基己酸、明矾或甲醛）、高压氧治疗（25%）、为尝试进行尿液转流而放置肾造口管（15%）和/或选择性膀胱血管栓塞术（5%）。
手术时患者的中位年龄为 77 岁（IQR 72，80），81%（21 例中的 17 例）为男性。出血性膀胱炎最常见的病因是前列腺癌的放射治疗（17 例，81%）。这些患者接受放射治疗至行膀胱切除术的中位时间为 91 个月（IQR 73，125）。行膀胱切除术时的美国麻醉医师协会（ASA）评分中位数为 3 分，术前血红蛋白中位数为 10.2g/dl。膀胱切除术后的中位住院时间为 10 天（IQR 7，19）。42%（19 例中的 8 例）患者发生严重（Clavien 分级 III 至 V 级）并发症，该队列的 90 天死亡率为 16%（19 例中的 3 例）。在中位术后随访 13 个月（IQR 4，21）时，1 年和 3 年的总生存率分别为 84%和 52%。
对于出血性膀胱炎，行膀胱切除术与围手术期并发症和死亡率高相关，这与该患者队列的基线临床状况一致，因此，在保守治疗失败后，膀胱切除术应作为控制出血的最后手段。
