Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
J Pediatr Urol. 2018 Oct;14(5):366-373. doi: 10.1016/j.jpurol.2018.03.018. Epub 2018 Apr 20.
Hemorrhagic cystitis (HC) is a serious event that can occur after hematopoietic stem cell transplantation (HSCT). Treatment goals are primarily to preserve life, and then the functionality of the bladder. There is no standard therapeutic approach for HC. Described treatment options provide low success rates and are related to potential life-threatening side effects. The aim of this study was to describe our experience in treatment of HC following HSCT.
This was a retrospective study of patients with HC treated at our institution between January 2010 and October 2016. We analyzed demographics, underlying diagnosis, and treatment modalities.
We treated 39 patients with HC. Mean age was 9.4 years (SD 4.20) and 64% were males. Acute leukemia was the most common underlying diagnosis in 27 (69%). Mean time from HSCT to HC onset was 55.46 days (SD 112.35). HC grades were: I (3), II (21), III (8), and IV (7). BK-viuria was present in 34 patients (87.2%). Non-invasive treatment was performed in 28 patients (71.8%). The remaining 11 (28.2%) required urological intervention (all high-grade), consisting of bladder irrigation in all of these. Additional treatments consisted of: intravesical cidofovir (4), intravesical sodium hyaluronate (5), cystoscopy and clot evacuation (4), selective angioembolization (2), percutaneous nephrostomy (1), and open extraction of bladder clots and cutaneous cystotomy (1). Overall, eight patients (20.5%) died as a result of the malignancy (3 in the urological intervention group), and of these four had active HC at death. Mean follow-up was 36.2 months (SD 24.9).
HC is associated with high morbidity and mortality. Treatment should be individualized and designed to prioritize survival. However, bladder function should be preserved for the future.
出血性膀胱炎（HC）是造血干细胞移植（HSCT）后可能发生的严重事件。治疗目标主要是挽救生命，其次是保护膀胱功能。对于 HC，目前尚无标准的治疗方法。所描述的治疗选择成功率低，且与潜在的危及生命的副作用有关。本研究旨在描述我们在 HSCT 后治疗 HC 的经验。
这是对 2010 年 1 月至 2016 年 10 月期间在我院接受 HC 治疗的患者进行的回顾性研究。我们分析了患者的人口统计学、基础诊断和治疗方式。
我们共治疗了 39 例 HC 患者。平均年龄为 9.4 岁（标准差 4.20），64%为男性。急性白血病是最常见的基础诊断，共 27 例（69%）。从 HSCT 到 HC 发病的平均时间为 55.46 天（标准差 112.35）。HC 分级为：Ⅰ级（3 例）、Ⅱ级（21 例）、Ⅲ级（8 例）和Ⅳ级（7 例）。34 例患者（87.2%）存在 BK 病毒尿。28 例患者（71.8%）进行了非侵入性治疗。其余 11 例（28.2%）需要泌尿科干预（均为高级别），所有患者均接受了膀胱冲洗。其他治疗包括：膀胱内给予更昔洛韦（4 例）、膀胱内透明质酸钠（5 例）、膀胱镜检查和血块清除（4 例）、选择性血管栓塞（2 例）、经皮肾造瘘（1 例）和开放提取膀胱血块和皮肤膀胱造口（1 例）。总体而言，8 例患者（20.5%）因恶性肿瘤死亡（泌尿科干预组 3 例），其中 4 例在死亡时仍有活动性 HC。平均随访时间为 36.2 个月（标准差 24.9）。
HC 发病率和死亡率高。治疗应个体化，旨在优先考虑生存。然而，应保留未来的膀胱功能。
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