Late effects on the urinary bladder in patients treated for cancer in childhood: A report from the Children's Oncology Group

Abstract

Childhood cancer survivors who have had pelvic or central nervous system surgery or have received alkylator-containing chemotherapy or pelvic radiotherapy as part of their cancer therapy may experience urinary bladder late effects. This article reviews the medical literature on longterm bladder complications in survivors of childhood cancer and outlines the Children's Oncology Group Long Term Followup (COG LTFU) Guidelines related to bladder function. An overview of the treatment of bladder late effects and recommended counseling for survivors with these complications are presented.Keywords urinary tract; urinary bladder; late effect; child; neoplasm Over the last several decades, improvements in treatment and supportive care have led to long-term survival rates for childhood cancer that exceed 80%.1 This success has produced a growing population of childhood cancer survivors who are at risk for a variety of medical complications and functional impairments related to their cancer or its treatment. Among the long-term effects described in childhood cancer survivors are abnormalities of bladder function. Severe impairment of bladder function due to pelvic or central nervous system surgery, pelvic radiotherapy, or alkylating agent chemotherapy may lead to hydronephrosis and/or renal dysfunction, sometimes necessitating reconstructive surgery to prevent renal function deterioration. Less severe bladder functional impairment may produce bothersome symptoms such as urinary frequency, urgency or incontinence that diminish quality of life. This paper will review how normal bladder function may be altered by pediatric cancer treatment. Methods of identifying patients at risk for bladder dysfunction will be discussed, with particular focus on the risk-based screening guidelines outlined by the Children's Correspondence: Michael Ritchey,

Target Inhibition of IL-1 Receptor Prevents Ifosfamide Induced Hemorrhagic Cystitis in Mice

“…normal epithelium (0), mild submucosal edema, mild hemorrhage, few ulcerations (1+), M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 6 and severe changes, such as cell infiltration, fibrin deposition, hemorrhage, and multiple ulcerations (2+). The results were expressed as median (min-max).…”

“…3,4 However, bladder inflammation can still be identified through cystoscopy in approximately one-third of patients. 5 Together with the evidence that HC can also lead to long-term bladder dysfunction, 6 even the presence of a mild cystitis cannot be undervalued. In this way, precise knowledge of the mechanisms and mediators underlying HC becomes crucial.…”

Common Musculoskeletal Tumors of Childhood and Adolescence

“…Examples are cardiac toxicity from anthracyclines, hearing loss or tinnitus from cisplatin, infertility from alkylator therapy or radiation to the pelvis, endocrine complications usually from radiation to reproductive organs or the hypothalamic-pituitary axis, bladder dysfunction from chemotherapy and radiation, and second malignant neoplasms due to radiation and/or chemotherapy. [88][89][90][91][92] Postpubertal boys should be offered semen cryopreservation before initiation of therapy. Cryopreservation of oocytes or embryos (the latter requires use of donor sperm) is possible for postpubertal females but may delay treatment initiation.…”

A Review on Surgical Techniques and Organ Sparing Procedures in Bladder/Prostate Rhabdomyosarcoma

“…Unfortunately, although the results of such studies in pediatric population are mostly preliminary, 18 they suggest that the outcome, even though initially acceptable, deteriorates over time. 19,20 Hence, late effects of irradiation of bladder and prostate during childhood on adult life remain unknown.…”