Cystotomy, temporary urinary diversion and bladder packing in the management of severe cyclophosphamide-induced hemorrhagic cystitis.
Severe hemorrhage from cyclophosphamide-induced cystitis sometimes requires aggressive open management when conventional endoscopic and intravesical therapies have failed. We present 2 patients with intractable hematuria who were managed by open cystotomy, temporary urinary diversion via external ureteral stents, and continuous postoperative bladder packing with gauze and hemostatic agents. Both patients had a dramatic improvement in the hematuria immediately postoperatively and 1 with prolonged followup has no urological disability. We suggest that this procedure be considered for management of severe hemorrhagic cystitis as an alternative to more aggressive surgical therapies, such as formal urinary diversion with cystectomy.
Andriole
G L
GL
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
Yuan
J J
JJ
Catalona
W J
WJ
D000208:Acute Disease; D000293:Adolescent; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects*; D003556:Cystitis / Q000139:chemically induced / Q000601:surgery*; D003559:Cystostomy; D006417:Hematuria / Q000139:chemically induced / Q000601:surgery*; D006689:Hodgkin Disease / Q000150:complications / Q000628:therapy; D006801:Humans; D015458:Leukemia, T-Cell / Q000150:complications / Q000628:therapy; D008297:Male; D015607:Stents; D001743:Urinary Bladder / Q000601:surgery*; D014547:Urinary Diversion
D003520:Cyclophosphamide