Management of ifosfamide induced hemorrhagic cystitis in a pediatric patient with pontine glioma (original) (raw)
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Post radiation hemorrhagic cystitis: MR findings
Magnetic Resonance Imaging, 1997
We report on the magnetic resonance findings in two patients wlth hemorrhagic cystitis secondary to radlation therapy. One patient's hladder wall was high in signal lntensity on T1-weighted fat-suppressed spolled gradient echo and low in signal intensity on Tz-weighted fat-suppressed spin echo images, findings consistent with intracellular methemoglohin in the settlng of subacute intramural hemorrhage. The second patient's bladder wall had regions that were low in signal intensity on T1-weighted fat-suppressed spht echo and hlgh in signal intensity on Tz-weighted fat-suppressed spin echo, and other regions that were high in signal intensity on T1-weighted fat suppressed spin echo and on Tz-weighted fat-suppressed spht echo images, findings that were consistent with active bleeding and late subacute hemorrhage, respectively. Imaging findings correlated with the patients' cliuical picture. Our two cases illustrate that magnetic resonance hnages may demonstrate changes of hemorrhagic cystitis and may permit determination of disease acuity. @ 1997 Elsevier Science Inc.
Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges
BJU International, 2013
Review therefore, the exact prevalence is unknown. Treatment can be problematic, especially in elderly patients who may be frail and have comorbidities [4], and because the condition often responds inadequately to the usual symptomatic therapies. In severe cases, HC is associated with significant morbidity, prolonged hospitalisation and occasional mortality, and may require more aggressive measures, e.g. supravesical urinary diversion, vesical artery selective embolization, and cystectomy [5]. Furthermore, as the global burden of cancer is forecast to rise, primarily due to ageing and growth of the world's population [6], it is likely that the incidence of HC will rise too because of the increasing use of RT and chemotherapy. However, there is currently a lack of consensus about the best treatment for patients with chemical-and RT-induced HC, as well as a lack of UK-led guidelines available on how it should optimally be defined and managed. The aim of the present article is to review the predisposing risk factors for chemical-and RT-induced HC and the evidence for the different therapeutic and preventive measures that have been used to help clinicians better manage this potentially disabling condition. Methods A comprehensive literature search was undertaken in PubMed to retrieve studies and case reports, published in English, relating to the treatment of chemical-and RT-induced HC from 1980 to September 2012. The search was conducted using a comprehensive search strategy, including the terms 'haemorrhagic cystitis' , 'chemical cystitis' , 'radiation cystitis' in combination with 'risk factors' , 'chemotherapeutic drugs' , 'hyaluronic acid' , 'sodium hyaluronate' , 'hyperbaric oxygen' , 'mesna' , 'hyperhydration' , 'bladder irrigation' , 'pentosanpolysulphate' , 'oestrogen' , 'recombinant factor VII' , 'formalin' , and 'prostaglandin'. The search results were supplemented by review of the bibliographies of key articles for additional studies, inclusion of relevant abstracts presented at key meetings, as well as expert input, to help ensure the capture of all pertinent data.
Background and Aim: Hemorrhagic cystitis (HC) is an inflammation of the urinary bladder defined by signs of urinary bladder irritation and hematuria. It is thought that damage to the Glycosaminoglycan-(GAG) layer, which coats the uroepithelium and provides the initial barrier for physiological protection, may be the first step in its development. The disease can be triggered by chemotherapeutic drugs exposure and radiation therapy. The incidence rate of HC is predicted to rise substantially in the future as more aggressive treatments of cancer are implemented.
Guidelines for the diagnosis, prevention and management of chemical- and radiation-induced cystitis
Journal of Clinical Urology, 2014
Objective Haemorrhagic cystitis (HC) is a relatively common complication of chemotherapy and radiotherapy to the pelvic area, but can be a challenging condition to treat, particularly since there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed. Materials and methods A comprehensive literature search was undertaken to evaluate the evidence for the diagnosis, prevention and management of cancer treatment-induced HC. Results Recommendations and a proposed management algorithm for the diagnosis, prevention and treatment of HC, as well as the management of intractable haematuria, have been developed based on the expert opinion of the multidisciplinary consensus panel following a comprehensive review of the available clinical data. Conclusion These guidelines are relevant and applicable to current clinical practice and will help clinicians optimally define and manage this potentially serious condition.
Risk factors and predictors of severity score and complications of pediatric hemorrhagic cystitis
2014
Purpose: We retrospectively analyzed our institutional incidence of hemorrhagic cystitis, identified risk factors, and examined associations of risk factors with disease severity and genitourinary complication rates. Materials and Methods: We reviewed charts of all consecutive pediatric patients treated from 1986 to 2010. We analyzed demographics, underlying diagnosis and treatment data to assess risk factors for hemorrhagic cystitis. We also correlated disease severity scores with clinical predisposing factors, and performed univariate and multivariate analyses to examine associations between risk factors and outcomes. Results: Hemorrhagic cystitis was observed in 97 of 6,119 children (1.6%), most of whom (75%) had severity scores of II or III. Mean AE SD age was 12.2 AE 6.3 years for patients with hemorrhagic cystitis and 10.5 AE 7 years for patients without hemorrhagic cystitis (p ΒΌ 0.017). On univariate analysis increased risk of hemorrhagic cystitis was significantly associated with age greater than 5 years, male gender, cyclophosphamide or busulfan chemotherapy, bone marrow or peripheral blood stem cell transplantation, pelvic radiotherapy and underlying diagnoses of rhabdomyosarcoma, acute leukemia and aplastic anemia. On multivariate analysis age greater than 5 years, allogeneic bone marrow or peripheral blood stem cell transplantation and pelvic radiotherapy were significantly associated with increased risk of hemorrhagic cystitis. Older age, late onset hemorrhagic cystitis, positive urine culture for BK virus and bone marrow or peripheral blood stem cell transplantation were associated with greater disease severity. Patients with higher severity scores more frequently experienced bladder perforation, hydronephrosis, overall hemorrhagic cystitis complications, and increased creatinine and blood urea nitrogen levels during followup. Conclusions: Older age, previous bone marrow or peripheral blood stem cell transplantation and BK virus in the urine are risk factors for hemorrhagic cystitis and are associated with a higher severity score. Higher severity scores are associated with increased rates of genitourinary complications and renal impairment.
Case reports in medicine, 2017
Treatment of pelvic neoplasms with radiotherapy may develop sequelae, especially RHC. An 85-year-old male patient was admitted to a hospital emergency with gross hematuria leading to urinary retention and was diagnosed with RHC. The urinary bladder was probed, unobstructed, and maintained in continuous three-way saline irrigation. During 45 days of hospitalization, the patient underwent two cystoscopic procedures for urinary bladder flocculation, whole blood transfusions, and one platelet apheresis. None of these interventions led to clinical resolution. As the patient hematological condition was deteriorating, dexamethasone (4 mg i.v., bolus of 6/6, 12/12, and 24 h during five days) and epoetin alpha (1000 IU, 1 ml, s.c., for four weeks) were administered which led to the remission of the urinary bleeding. Dexamethasone therapy may be considered for RHC, when conventional treatments are not effective or are not possible, avoiding more aggressive interventions such as cystectomy.
Chronic Radiation cystitis: a review of medical and surgical management
Journal of Drug Delivery and Therapeutics
Radiation cystitis is a complication of radiation treatment given for pelvic malignancies. Radiation cystitis can present as mild symptoms of dysuria, frequency, and hematuria to severe life-threatening complications like intractable hematuria, bladder perforation and contracted non-functional urinary bladder, fistula etc. Treatment is tailored according to the severity of symptoms and available treatment modalities sequentially. Initial treatment of hematuria is intravenous fluids, blood transfusions, cystoscopy and fulguration, irrigation with intravesical agents like alum, hyperbaric oxygen therapy, angioembolisation, urinary diversion and surgery (cystectomy). Radiation cystitis is associated with short- and long-term complications in pelvic malignancies patients. Early diagnosis, follow up, treatment is crucial for decreasing morbidity and mortality in these patients. In this review article we describe the current protocol in diagnosing and managing radiation cystitis. Keywords...