Abstract
Objective To explore the efficacy of cystoscopy for late onset hemorrhagic cystitis (LOHC) after hematopoietic stem cell transplantation (HSCT). Methods Retrospective analysis was conducted for 11 hospitalized children with severe LOHC after HSCT receiving cystoscopy after ineffective conservative treatment from January 2014 to May 2017.Twenty-four-Foley(24F) resectoscope, 18F nephroscope or 8/9.8F ureteroscope was employed according to urinary tract development.Blood clot in bladder was removed by electronic loop, Elick irrigator, 3.3 mm ultrasonic lithotripsy probe and basket.Then bipolar or monopolar electrocoagulation was utilized for hemostasis. Results There were 7 boys and 4 girls with a median age of 9 (5-15) years.The median occurring time of LOHC after HSCT was 35 days (21-85 days) and the median time of initial cystoscopy after LOHC 57 (11-182) days.The grades of LOHC were III LOHC (n=7, 63.7%) and IV (n=4, 36.3%). A total of 14 endoscopic operations were performed with a median operative duration of 76 (43-179) min.LOHC was cured in 8 children (72.7%) and improved in another (9.1%). The overall response rate was 81.8%.Two children (18.2%) responded to neither cystoscopy nor subsequent selective bladder artery embolization plus internal iliac artery embolization.And both ultimately died of non-operative-related pulmonary infection at 1 week and 1 month post-operation respectively.In 8 children with complete remission, gross hematuria disappeared at 4 (3-10) days post-operation and microscopic hematuria disappeared at 30 (25-38) days post-operation.There was no onset of severe postoperative complications.Both operative duration and effective ratio had statistical differences between children with grades III and IV LOHC (P=0.038, 0.044). Conclusions For children with severe LOHC after HSCT, cystoscopy is both safe and effective.If conservative therapy fails, surgery should be performed as soon as possible. Key words: Cystitis; Hematopoietic stem cell transplantation; Cystoscopes
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