Multivariate analysis of factors predicting surgical intervention for hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

Hemorrhagic cystitis(HC),which is characterized by a congested vasculature and extensive hemorrhage in the bladder lamina propria,is often secondary to chemotherapy,external radiation therapy,allogeneic hematopoietic stem cell transplantation(Allo-HSCT),and/or opportunistic infection.[1]The incidence of HC after Allo-HSCT has been reported to range between 1.3%and 20%.[2]The severity of HC may vary from bladder irritation symptoms with mild hematuria,which is observed in most cases and is resolved with conservative management,such as adequate hydration and bladder irrigation,to transfusion-dependent hemorrhage and/or a lower urinary tract obstruction post renal failure.Other strategies,including bladder irrigation with intravesical alum,formalin,aminocaproic acid,or prostaglandin and hyperbaric oxygen therapy,have been reported,with the resolution of bleeding in the majority of cases.[3]However,for patients in whom these measures fail and the lower urinary tract becomes obstructed by numerous blood clots,further surgery,including internal iliac angioembolization,cystoscopy with control of bladder hemorrhage and cystectomy,should be considered.[4]