Introduction of sodium pentosan polysulfate and avoidance of urethral catheterisation: improved outcomes in children with haemorrhagic cystitis post stem cell transplant/chemotherapy.
OBJECTIVE
Haemorrhagic cystitis (HC) is an uncommon but potentially devastating complication of chemotherapy and bone marrow transplantation in children. We aimed to test the hypothesis that early recognition, sodium pentosan polysulfate (SPP), and avoidance of urethral catheterisation improve outcomes in children with HC.


METHODS
A retrospective case note review was performed of all patients treated for HC in our hospital from 2002 to 2010. A protocol for the management of HC was introduced in 2007 advocating early detection, use of SPP, and avoidance of urethral catheterisation. Data collected on each patient included primary condition, medications at onset, blood transfusions, duration of symptoms, catheter usage, and outcome. Statistical analysis was performed using the Mann-Whitney U test, and Fisher's Exact test as appropriate, P < .05 being significant.


RESULTS
Five patients were treated using protocol with 5 historical controls. There was no significant difference between the ages of the group, diagnosis, and treatment at onset of HC. In the historical group, 4 of 5 died with HC, but all recovered in the protocol group (P < .05). Blood transfusion requirements were also significantly reduced after protocol introduction (P < .05).


CONCLUSIONS
Early identification, avoidance of urethral catheterisation, and use of SPP significantly reduces blood transfusion requirements and mortality from HC.
Department of Paediatric Urology, Birmingham Children's Hospital, Steelhouse Lane, B6 4NH Birmingham, UK.
Gillian
G
Duthie
Lisa
L
Whyte
Harish
H
Chandran
Sarah
S
Lawson
Mark
M
Velangi
Liam
L
McCarthy
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001739:BK Virus; D002648:Child; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects; D003556:Cystitis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D005199:Fanconi Anemia / Q000188:drug therapy / Q000601:surgery; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006417:Hematuria / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D006566:Herpesviridae Infections / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D007938:Leukemia / Q000188:drug therapy / Q000601:surgery; D008297:Male; D015080:Mesna / Q000627:therapeutic use; D010426:Pentosan Sulfuric Polyester / Q000008:administration & dosage / Q000627:therapeutic use*; D027601:Polyomavirus Infections / Q000150:complications; D011183:Postoperative Complications / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D011446:Prospective Studies; D014463:Ultrasonography; D014546:Urinary Catheterization / Q000009:adverse effects*
D010426:Pentosan Sulfuric Polyester; D003520:Cyclophosphamide; D015080:Mesna