PURPOSE: To evaluate the clinical presentation, management and outcomes for patients undergoing cystectomy for refractory hemorrhagic cystitis.
METHODS: We identified 21 patients with refractory hematuria treated with cystectomy at our institution between 2000-2012. Prior to cystectomy, all patients had failed clot evacuation, bladder fulguration, and bladder irrigation. Additionally, 45% had received prior intravesical therapy (Amicar, Alum, or Formalin), hyperbaric oxygen therapy (25%), nephrostomy tube placement for attempted urinary diversion (15%), and/or selective bladder angioembolization (5%).
RESULTS: Median patient age at surgery was 77 years (IQR 72,80), while 81% (17/21) were male. The most common etiology for hemorrhagic cystitis was prior radiation therapy for prostate cancer (17; 81%). Median time from receipt of radiation to cystectomy in these patients was 91 months (IQR 73,125). Median American Society of Anesthesiologists Score at cystectomy was 3, while the median pre-operative hemoglobin was 10.2 g/dL. Median length of stay following cystectomy was 10 days (IQR 7, 19). Severe (Clavien Grade III-V) complications were noted in 42% of patients (8/19) and the 90-day mortality rate in this cohort was 16% (3/19). With a median postoperative follow-up of 13 months (IQR 4, 21) the 1 and 3-year overall survival was 84% and 52%, respectively.
CONCLUSIONS: Cystectomy for hemorrhagic cystitis is associated with a high risk of perioperative complications and mortality, consistent with the baseline clinical status of this patient cohort, and as such should remain a last resort to control bleeding after failure of conservative measures.
Written by:
Linder BJ, Tarrell RF, Boorjian SA. Are you the author?
Department of Urology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Reference: J Urol. 2014 Jun 14. pii: S0022-5347(14)03782-3.
doi: 10.1016/j.juro.2014.06.030
PubMed Abstract
PMID: 24936722
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