PURPOSE: We retrospectively analyzed our institutional incidence of hemorrhagic cystitis (HC), identified risk factors, and examined associations of those factors with HC severity and genitourinary complication rates.
METHODS: We reviewed charts of all consecutive pediatric patients treated from 1986 and 2010. We analyzed demographics, underlying diagnosis, and treatment data to assess risk factors for developing HC; correlated HC severity scores with clinical predisposing factors; and performed univariate and multivariate analyses to examine associations between risk factors and outcome.
RESULTS: Ninety-seven (1.6%) of 6119 children developed HC, most (75%) with severity scores of II or III. Average age at HC diagnosis was 12.2±6.3 years vs 10.5±7 years for patients without HC (P=0.017). On univariate analysis, increased HC risk was significantly associated with age >5 years, male sex, cyclophosphamide or busulfan chemotherapy, bone marrow or peripheral blood stem cell transplantation (BMT/PBSCT), pelvic radiotherapy (PRT), and underlying diagnoses of rhabdomyosarcoma, acute leukemia, and aplastic anemia. On multivariate analysis, age >5 years, allogenic BMT/PBSCT, and PRT were significantly associated with increased HC risk. Older age, late-onset HC, positive urine culture for BK virus, and BMT/PBSCT were associated with greater HC severity. Those with higher severity scores more frequently experienced bladder perforation, hydronephrosis, overall HC complications, and increased creatinine and blood urea nitrogen levels during follow-up.
CONCLUSIONS: Older age, previous BMT/PBSCT, and BK virus in the urine are risk factors for HC and are associated with a worse severity score. Higher severity scores were associated with increased rates of genitourinary complications and renal impairment.
Written by:
Riachy E, Krauel L, Rich BS, McEvoy MP, Honeyman JN, Boulad F, Wolden SL, Herr HW, La Quaglia MP. Are you the author?
Pediatric Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Reference: J Urol. 2013 Aug 13. pii: S0022-5347(13)05103-3.
doi: 10.1016/j.juro.2013.08.007
PubMed Abstract
PMID: 23954584
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