"G. D'Annunzio" University of Chieti, Dept. of Medical, Oral and Biotechnological Sciences, "SS. Annunziata" Hospital, Urology Unit, Chieti, Italy; ASL Abruzzo 2, Department of Urology, Chieti.
"SS. Annunziata" Hospital, Chieti, Italy; ASL Abruzzo 2, Servizio di Medicina Trasfusionale ed Ematologia Aziendale Ospedaliero - Centro Emofilia 52, Chieti.
Arch Ital Urol Androl. 2021 Jun 28;93(2):200-205. doi: 10.4081/aiua.2021.2.200.
Fibrin glue (FG) endo-vesical application seems to be a promising therapy for hemorrhagic cystitis (HC). We aimed to evaluate efficacy and safety of FG instillation in patients with HC.
Patients with HC not responsive to conventional treatments (bladder irrigation, catheterization, blood transfusions, hyperhydration and endoscopic coagulation) were treated with FG endo-vesical instillation (April 2017- December 2018). FG was prepared from 120 mL of patient blood with the Vivostat® system. After standard cystoscopy, bladder was insufflated with carbon dioxide (CO2) according to bladder compliance and autologous FG was applied to bladder wall and bleeding sites.
Ten patients included with grade 2 or higher HC secondary to bone marrow graft for hematological diseases (30%) or to actinic cystitis caused by prostate cancer radiotherapy (RT) (70%). The median HC onset time after RT was 4.8 (IQR 3.9- 6.3) years and 35 (IQR 27.5-62.5) days after hematopoietic stem cell transplantation (HSCT). Five patients had a complete response after one treatment, three patients had clinical response (grade < 2 hematuria, amelioration of symptoms), one of them required catheterization and bladder irrigation. One patient required a second instillation of FG achieving a clinical response. No adverse events related to the procedure were recorded, however one patient died for causes not related to the procedure. Median Interstitial Cystitis Symptoms Index was 13.0 (IQR 11.0-15.0) pre-operatively and 4.0 (IQR 2.0-5.0) post-operatively.
Our study showed that, even in hematological patients, autologous FG instillation maybe a safe, repeatable and effective treatment modality in patients with refractory HC.
纤维蛋白胶（FG）经尿道内应用似乎是治疗出血性膀胱炎（HC）的一种很有前途的治疗方法。我们旨在评估 FG 膀胱内灌注治疗 HC 的疗效和安全性。
对常规治疗（膀胱冲洗、导尿、输血、补液和内镜下凝固）无效的 HC 患者采用 FG 经尿道内灌注治疗（2017 年 4 月至 2018 年 12 月）。FG 由 Vivostat®系统从 120ml 患者血液中制备而成。标准膀胱镜检查后，根据膀胱顺应性向膀胱内注入二氧化碳（CO2），并将自体 FG 应用于膀胱壁和出血部位。
共纳入 10 例患者，其中 3 例（30%）继发于血液系统疾病的骨髓移植，7 例（70%）继发于前列腺癌放疗（RT）导致的光化性膀胱炎。RT 后 HC 的中位发病时间为 4.8 年（IQR 3.9-6.3），造血干细胞移植（HSCT）后 35 天（IQR 27.5-62.5）。5 例患者经一次治疗后完全缓解，3 例患者临床反应（血尿程度<2 级，症状改善），其中 1 例需导尿和膀胱冲洗。1 例患者需再次 FG 灌注治疗，临床反应良好。无与操作相关的不良事件，但有 1 例患者因与操作无关的原因死亡。术前膀胱疼痛症状指数中位数为 13.0（IQR 11.0-15.0），术后为 4.0（IQR 2.0-5.0）。
即使在血液系统疾病患者中，自体 FG 灌注治疗可能是一种安全、可重复、有效的难治性 HC 治疗方法。
