title: Hemorrhagic Cystitis Requiring Bladder Irrigation is Associated with Poor Mortality in Hospitalized Stem Cell Transplant Patients.
abstract: OBJECTIVE
  To evaluate the overall prognosis of post-stem cell transplant inpatients who required continuous bladder irrigation (CBI) for hematuria.
  
  
  METHODS
  We performed a retrospective analysis of adult stem cell transplant recipients who received CBI for de novo hemorrhagic cystitis as inpatients on the bone marrow transplant service at Washington University from 2011-2013. Patients who had a history of genitourinary malignancy and/or recent surgical urologic intervention were excluded. Multiple variables were examined for association with death.
  
  
  RESULTS
  Thirty-three patients met our inclusion criteria, with a mean age of 48 years (23-65). Common malignancies included acute myelogenous leukemia (17/33, 57%), acute lymphocytic leukemia (3/33, 10%), and peripheral T cell lymphoma (3/33, 10%). Median time from stem cell transplant to need for CBI was 2.5 months (0 days-6.6 years). All patients had previously undergone chemotherapy (33/33, 100%) and 14 had undergone prior radiation therapy (14/33, 42%). Twenty-eight patients had an infectious disease (28/33, 85%), most commonly BK viremia (19/33, 58%), cytomegalovirus viremia (17/33, 51%), and bacterial urinary tract infection (8/33, 24%). Twenty-two patients expired during the same admission as CBI treatment (22/33 or 67% of total patients, 22/28 or 79% of deaths), with a 30-day mortality of 52% and a 90-day mortality of 73% from the start of CBI.
  
  
  CONCLUSIONS
  Hemorrhagic cystitis requiring CBI is a symptom of severe systemic disease in stem cell transplant patients. The need for CBI administration may be a marker for mortality risk from a variety of systemic insults, rather than directly attributable to the hematuria.
authors.affiliation: Division of Urology, Washington University School of Medicine, Washington, DC, USA.
authors.forename: Valary T
authors.initials: VT
authors.lastname: Raup
authors.affiliation: Division of Urology, Washington University School of Medicine, Washington, DC, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Potretzke
authors.affiliation: Division of Urology, Washington University School of Medicine, Washington, DC, USA.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Manley
authors.affiliation: Division of Urology, Washington University School of Medicine, Washington, DC, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Brockman
authors.affiliation: Division of Urology, Washington University School of Medicine, Washington, DC, USA.
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D003556:Cystitis / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality*; D006417:Hematuria / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation / Q000379:methods; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult