title: [Significance of Urological Surgical Treatment for Viral Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation].
abstract: This study investigated the significance of urological surgical intervention for viral hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 1, 024 patients underwent allo-HSCT at our medical center between January 2006 and July 2014. In the 6 patients (0.58%) who required urological surgical treatment for viral HC, we retrospectively analyzed patient characteristics and outcomes. Two patients underwent nephrostomy for bilateral hydronephrosis due to bladder tamponade. One of these patients showed no improvement in renal function, graft versus host disease worsened and he died on postoperative day (POD) 5. The other patient displayed improved renal function but hematuria did not improve, and total cystectomy was required. To control bleeding, we performed transurethral electrocoagulation (TUC) on 3 patients, and total cystectomy was performed on 2 patients. All 3 patients who underwent TUC had BK virus HC. Two of these patients experienced marked improvement in hematuria from immediately after surgery. Hemostasis was only temporary in the other patient, who eventually died due to septicemia on POD 24. The 2 patients who underwent total cystectomy had adenovirus HC. Both experienced secondary hemorrhage postoperatively and required further surgery. Eventually, one died due to postoperative bleeding on POD 1, and one died due to postoperative pneumonia on POD 57. Urological surgical treatment for HC was effective in some cases, but the ultimate outcome greatly depends on the general condition of the patient and treatment of the underlying hematological disorder. TUC may be considered for HC (particularly BK virus HC), but total cystectomy (especially inaden ovirus HC) should be avoided.
authors.affiliation: The Department of Urology, Toranomon Hospital.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kurosawa
authors.affiliation: The Department of Urology, Toranomon Hospital.
authors.forename: Shinji
authors.initials: S
authors.lastname: Urakami
authors.affiliation: The Department of Hematology, Toranomon Hospital.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Ishiwata
authors.affiliation: The Department of Urology, Toranomon Hospital.
authors.forename: Jinpei
authors.initials: J
authors.lastname: Miyagawa
authors.affiliation: The Department of Urology, Toranomon Hospital.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Sakaguchi
authors.affiliation: The Department of Urology, Toranomon Hospital.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujioka
authors.affiliation: The Department of Urology, Toranomon Hospital.
authors.forename: Hirokatsu
authors.initials: H
authors.lastname: Murata
authors.affiliation: The Department of Diagnostic Pathology, Toranomon Hospital.
authors.forename: Naoko
authors.initials: N
authors.lastname: Inoshita
authors.affiliation: The Department of Hematology, Toranomon Hospital.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.affiliation: The Department of Urology, Toranomon Hospital.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Okaneya
mesh_terms: D000328:Adult; D003556:Cystitis / Q000601:surgery* / Q000821:virology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006417:Hematuria / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000209:etiology*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000209:etiology*; D013520:Urologic Surgical Procedures; D055815:Young Adult