Abstract No. 213 Efficacy for urinary diversion via percutaneous nephrostomy tubes to treat hemorrhagic cystitis

Abstract

Hemorrhagic cystitis (HC) is diffuse hemorrhage of the bladder mucosa that can lead to anemia requiring transfusions and bladder outlet obstruction. In severe cases that are refractory to conservative treatment, urinary diversion utilizing percutaneous nephrostomy tubes (PCN) has been reported. However, there is a paucity of data regarding the efficacy and safety of PCNs for severe HC. We present the largest case series to date of HC treated with PCNs for urinary diversion. An IRB-approved, retrospective, single-center cohort study was conducted in patients with HC who had PCNs placed for urinary diversion between 2004 and 2020. Diagnosis of HC was determined on clinical and/or cystoscopic examination. 24 patients (median age 59 years; 17/7 M/F ratio) were identified. Etiology of HC included radiation (12), BK virus (6), and other (6), with a median CTCAE severity grade of 3 (range 2-4). Mann-Whitney test with P value < 0.05 was used to determine significance. PCN placement procedure had a primary technical success rate of 23/24 (96%). Median post-procedure CTCAE severity score was 1 (range 0-4), a mean decrease of 1.95 compared to pre-procedure. Resolution of hematuria occurred in 17/24 cases (71%); median time for hematuria to resolve after procedure was 12 days (range 3-71). Postoperative hemoglobin increased (mean 7.4 g/dL at the time of procedure to 8.3 g/dL 3 days post-operative, P< 0.05) and transfusion requirement decreased (mean 7.3 units PRBC within 30 days prior to the procedure to 3.4 units PRBC within 30 days following the procedure, P< 0.05). 4/17 patients demonstrated subsequent recurrence of hematuria; median time to recurrence of hematuria was 60 days (range 12-200). 5/24 patients died within 30 days of the procedure; however, no death was attributed directly to HC or PCN placement. Urinary diversion from PCN placement is a safe and efficacious treatment for severe, treatment-refractory HC.