Hemorrhagic cystitis: A challenge to the urologist

Manikandan, Ramanitharan; Kumar, Sheetanshu; Dorairajan, Lalgudi Narayanan

doi:10.4103/0970-1591.65380

Cited by 111 publications

(68 citation statements)

References 67 publications

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“…Although no definitive treatment is currently available, various interventions are currently used for both radiation and hemorrhagic cystitis. 17 …”

Section: Discussionmentioning

confidence: 99%

Intravesical Liposomal Tacrolimus Protects against Radiation Cystitis Induced by 3-Beam Targeted Bladder Radiation

et al. 2015

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Purpose This study primarily sought to determine if the Small Animal Radiation Research Platform (SARRP) can create a rat radiation cystitis (RC) model via targeted bladder irradiation (phase I). The response to treatment of early phase RC in rats via transurethral catheter instillation of liposomal tacrolimus (lipo-tacrolimus) was examined in phase II. Materials and Methods In phase I, 16 adult female Sprague-Dawley rats were used and their metabolic urination patterns were analyzed before and after exposure to 20, 30, or 40 Gy radiation. In phase II, irradiated rats were randomly assigned to receive a single instillation of either saline or lipo-tacrolimus. Results The 40 Gy radiation dose induced statistically significant reductions in inter-micturition intervals (IMI) compared to the lower doses of radiation. 40 Gy radiation caused a significant reduction in mean IMI by approximately 20 minutes (p < 0.0001). Histological analysis indicated degenerative type epithelial changes and urothelial swelling, with evidence of pseudocarcinomatous epithelial hyperplasia. Therefore, 40 Gy was chosen for the phase II efficacy study. There was no measurable change in total voided urine volume after irradiation or after instillation of lipo-tacrolimus or saline. Lipo-tacrolimus treatment significantly increased post-irradiation IMI values by approximately 30 minutes (p < 0.001) back to baseline levels. Conclusions The RC rat model demonstrated a dose-dependent decrease in IMI without inducing short-term skin or gastrointestinal damage. This study demonstrated that lipo-tacrolimus may be a promising new intravesical therapy for the rare and serious condition of RC.

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“…Although no definitive treatment is currently available, various interventions are currently used for both radiation and hemorrhagic cystitis. 17 …”

Section: Discussionmentioning

confidence: 99%

Intravesical Liposomal Tacrolimus Protects against Radiation Cystitis Induced by 3-Beam Targeted Bladder Radiation

et al. 2015

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“…HE is a general inflammatory condition of the urinary bladder [ 12 ] characterized by intense pain, edema, bleeding, ulceration, necrosis, and leukocyte infiltration [ 13 ]. HE is usually associated with the use of the anticancer drug cyclophosphamide (CYP) [ 12 ]. The incidence of HE is correlated with the CYP dosage and can be higher than 75% [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Quinovic Acid Glycosides Purified Fraction from Uncaria tomentosa Protects against Hemorrhagic Cystitis Induced by Cyclophosphamide in Mice

et al. 2015

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Uncaria tomentosa is widely used in folk medicine for the treatment of numerous diseases, such as urinary tract disease. Hemorrhagic cystitis (HE) is an inflammatory condition of the bladder associated with the use of anticancer drugs such as cyclophosphamide (CYP). Sodium 2-mercaptoethanesulfonate (Mesna) has been used to prevent the occurrence of HE, although this compound is not effective in established lesions. It has been demonstrated that the purinergic system is involved in several pathophysiological events. Among purinergic receptors, P2X7 deserves attention because it is involved in HE induced by CYP and, therefore, can be considered a therapeutic target. The objective of this study was to investigate the potential therapeutic effect of the quinovic acid glycosides purified fraction (QAPF) from U. tomentosa in the mouse model of CYP-induced HE. Pretreatment with QAPF not only had a protective effect on HE-induced urothelial damage (edema, hemorrhage and bladder wet weight) but was also able to control visceral pain, decrease IL-1β levels and down-regulates P2X7 receptors, most likely by inhibit the neutrophils migration to the bladder. This research clearly demonstrates the promising anti-inflammatory properties of QAPF, supporting its use as complementary therapy. QAPF represents a promising therapeutic option for this pathological condition.

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“…Some patients after alloHSCT have refractory HC and require alternative intravesical treatment regiments. Several therapies were evaluated including chondroitin sulfate, sodium hyaluronate, prostaglandins (PGE1, PGE2, PGF2α), formalin, and alum irrigation but results were not satisfactory [8][9][10]. Systemic treatments, e.g., estrogen, sodium pentosanpolysulphate, recombinant factor VIIa or VIII, and aminocapronic acid have been used with some successful results but toxic effects were observed [8,[11][12][13].…”

Section: Discussionmentioning

confidence: 98%

“…The optimal treatment of HC is still not established. Mesna, hyperhydratation, and bladder irrigation appear to be the most frequently used prophylactic procedures for treatment-related HC with varying results [7][8][9]. Some patients after alloHSCT have refractory HC and require alternative intravesical treatment regiments.…”

Section: Discussionmentioning

confidence: 98%

The use of hyperbaric oxygen therapy in the treatment of hemorrhagic cystitis after allogeneic stem cell transplantation from an unrelated donor

et al. 2015

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Hemorrhagic cystitis (HC) is a diffuse inflammation of the bladder of an infectious or non-infectious etiology, causing bleeding of the bladder mucosa. There are no explicit guidelines defining the appropriate treatment of HC. Hyperbaric oxygen therapy (HBO) is a non-invasive method involving the use of 100 % oxygen under increased pressure, which penetrates to poorly perfused areas. The most appropriate group for treatment with HBO is patients with BK virus-associated HC after allogenic human stem cell transplantation (alloHSCT). In this report, we present five patients after alloHSCT from a matched unrelated donor with symptoms of HC successfully treated with HBO. All patients received therapy with 100 % oxygen in a hyperbaric chamber at 2.5 atmospheres for 60 min, delivered 5 days per week. Complete response with resolution of pain and hematuria, as well as eradication of viral load, was achieved by all the patients after a mean of 13 sessions (range 11-30) of HBO. These data indicate that HBO therapy is sufficient and effective in the treatment of HC, and represents a well-tolerated procedure with good clinical and laboratory results after ineffective primary treatment.

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Hemorrhagic cystitis: A challenge to the urologist

Cited by 111 publications

References 67 publications

Intravesical Liposomal Tacrolimus Protects against Radiation Cystitis Induced by 3-Beam Targeted Bladder Radiation

Intravesical Liposomal Tacrolimus Protects against Radiation Cystitis Induced by 3-Beam Targeted Bladder Radiation

The Quinovic Acid Glycosides Purified Fraction from Uncaria tomentosa Protects against Hemorrhagic Cystitis Induced by Cyclophosphamide in Mice

The use of hyperbaric oxygen therapy in the treatment of hemorrhagic cystitis after allogeneic stem cell transplantation from an unrelated donor

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