title: Urologic Outcomes of Children With Hemorrhagic Cystitis After Bone Marrow Transplant at a Single Institution.
abstract: OBJECTIVE
  To analyze clinical outcomes and the risk factors associated with genitourinary (GU) morbidity and mortality in children who present with hemorrhagic cystitis (HC) after bone marrow transplant (BMT).
  
  
  METHODS
  A retrospective chart review of patients with HC who had undergone BMT at a single pediatric hospital from 2008 to 2015 was conducted. Demographic data, severity of hematuria, HC management, and mortality were analyzed. Bivariate analysis and binary logistic regression were performed to identify risk factors.
  
  
  RESULTS
  Out of 43 patients who met inclusion criteria, 67.4% were male with a median age at BMT of 10.2 years (interquartile range 5.8-14.6). Percutaneous nephrostomy catheters were inserted in 5 patients for urinary diversion. All-cause mortality was 32.6% (N = 14). Intravesical retroviral therapy (P <.001), HC grade (P <.001), total Foley time (P <.001), total gross hematuria time (P <.001), total days hospitalized (P = .012), and days to most improved hematuria (P = .032) were associated with significant GU morbidity on bivariate analysis. On multivariable analysis, days to most improved hematuria was associated with significant GU morbidity odds ratio of 1.177 (1.006-1.376) (P = .042). Status of percutaneous nephrostomy was not associated with increased mortality (P = .472); however, in the multivariate model, BK viremia (P = .023), need for renal dialysis (P = .003), and presence of Foley catheter (P = .005) were associated with increased mortality.
  
  
  CONCLUSIONS
  Children with HC after BMT fall in a very high-risk category with high mortality and significant GU morbidity. The presence of a Foley catheter, need for dialysis, and BK viremia are associated with increased mortality.
authors: Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
authors: Jason K
authors: JK
authors: Au
authors: Scott Department of Urology, Baylor College of Medicine, Houston, TX.
authors: Christopher
authors: C
authors: Graziano
authors: Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
authors: Rodolfo A
authors: RA
authors: Elizondo
authors: Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
authors: Sheila
authors: S
authors: Ryan
authors: Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
authors: David R
authors: DR
authors: Roth
authors: Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
authors: Chester J
authors: CJ
authors: Koh
authors: Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
authors: Edmond T
authors: ET
authors: Gonzales
authors: Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
authors: Duong T
authors: DT
authors: Tu
authors: Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
authors: Nicolette
authors: N
authors: Janzen
authors: Department of Hematology/Oncology, Texas Children's Hospital//Baylor College of Medicine, Houston, TX.
authors: Swati
authors: S
authors: Naik
authors: Department of Pediatric Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX. Electronic address: axseth@texaschildrens.org.
authors: Abhishek
authors: A
authors: Seth
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000401:mortality; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D003556:Cystitis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D009017:Morbidity / Q000639:trends; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents