Hyberbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis

ABSTRACT Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis. Materials and methods Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up. Conclusions Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option.

Embolização vesical superseletiva para tratamento de hematúria maciça por cistite actínica / Selective vesical artery embolization for treatment of gross hematuria due to actinic cystitis

Os autores relatam o caso de uma paciente de 46 anos de idade, que, após ter sido submetida a tratamento radioterápico por neoplasia de colo uterino, desenvolveu cistite actínica com episódios frequentes de hematúria franca. A paciente necessitou ser submetida a repetidos cateterismos vesicais por retenção urinária, hemotransfusões e internacões hospitalares. As medidas conservadoras e as tentativas de hemostasia por cistoscopia não foram bem-sucedidas no controle do sangramento. A paciente foi então submetida a tratamento endovascular com embolização superseletiva das artérias vesicais e outros pedículos vasculares, que se demonstraram associados ao sangramento. O procedimento foi bem-sucedido e a paciente vem sendo acompanhada há nove meses sem a necessidade de novas hemotransfusões nem de novas internações hospitalares. De acordo com a revisão da literatura, o uso dessa técnica ainda não havia sido descrito em trabalhos brasileiros.

This article describes the case of a 46-year-old female patient who had been treated with radiotherapy for cervical cancer. She developed actinic cystitis with frequent episodes of severe hematuria. She required repeated catheterization to manage urinary retention, blood transfusions and hospital admissions. Conservative measures and attempts to achieve hemostasis by cystoscopy were unsuccessful at controlling bleeding. The patient therefore underwent endovascular treatment with superselective embolization of the vesical arteries and other vascular pedicles found to be linked with the bleeding. The procedure was successful and the patient has been in follow-up for 9 months with no need for further blood transfusions or admission to hospital. According to a review of the literature, use of this technique has not previously been described in Brazil.

Hemorrhagic Cystitis Requiring Bladder Irrigation is Associated with Poor Mortality in Hospitalized Stem Cell Transplant Patients

Purpose: To evaluate the overall prognosis of post-stem cell transplant inpatients who required continuous bladder irrigation (CBI) for hematuria. Materials and Methods: We performed a retrospective analysis of adult stem cell transplant recipients who received CBI for de novo hemorrhagic cystitis as inpatients on the bone marrow transplant service at Washington University from 2011-2013. Patients who had a history of genitourinary malignancy and/or recent surgical urologic intervention were excluded. Multiple variables were examined for association with death. Results: Thirty-three patients met our inclusion criteria, with a mean age of 48 years (23-65). Common malignancies included acute myelogenous leukemia (17/33, 57%), acute lymphocytic leukemia (3/33, 10%), and peripheral T cell lymphoma (3/33, 10%). Median time from stem cell transplant to need for CBI was 2.5 months (0 days-6.6 years). All patients had previously undergone chemotherapy (33/33, 100%) and 14 had undergone prior radiation therapy (14/33, 42%). Twenty-eight patients had an infectious disease (28/33, 85%), most commonly BK viremia (19/33, 58%), cytomegalovirus viremia (17/33, 51%), and bacterial urinary tract infection (8/33, 24%). Twenty-two patients expired during the same admission as CBI treatment (22/33 or 67% of total patients, 22/28 or 79% of deaths), with a 30-day mortality of 52% and a 90-day mortality of 73% from the start of CBI. Conclusions: Hemorrhagic cystitis requiring CBI is a symptom of severe systemic disease in stem cell transplant patients. The need for CBI administration may be a marker for mortality risk from a variety of systemic insults, rather than directly attributable to the hematuria.

Is there a role for hyberbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? a prospective pilot-feasibility study and review of literature

Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. Materials and Methods Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. Conclusions Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option. .

[Comparison of single dose and three-day course of cefixime in the treatment of women with uncomplicated acute cystitis referred to health care center in Tehran]

The aim of this study was to compare the efficacy of single dose and three days course of cefiximein in the treatment of women with uncomplicated acute cystitis. This clinical trial was done on 70 women with uncomplicated acute cystitis referred to urologic and gynecologic clinic at Bou Ali hospital in Tehran [Iran], which were randomly divided into two groups. The first group [group A] was prescribed one 800 mg dose of cefixime and the 2[nd] group [group B] was treated with 400mg/day cefixime for 3 days. After one week and 2 week of taking the prescribed antibiotics, urine culture was analyzed. Patients with resistant urine culture to cefixime [3 in group A and 2 in group B] were excluded from the study. Data were analyzed using t-test, chi- square and exact Fisher test using SPSS-16 software. The mean [ +/- standard deviation] age of subjects was 29.97 +/- 5.65. Seventeen subjects in group A and 21 in group B were married. All subjects, excluding six [1 in group A and 5 in group B], were completely cured. However, recoveries in group A were more than group B, but there was no statistically significant difference. Single 800 mg dose of cefixime is as effective as dose of 400 mg/day for 3 days in treatment of women with uncomplicated acute cystitis

Infecciones del tracto urinario / Urinary tract infections

La infección del tracto urinario (ITU), con sus múltiples presentaciones clínicas, está entre las enfermedades infecciosas más frecuentes, tanto en pacientes ambulatorios como hospitalizados. El uso del examen de orina completa y de urocultivo debe ser racional. La bacteriuria asintomática no debe ser buscada ni tratada, en parte porque esto favorece el desarrollo de bacterias resistentes a antibióticos. Distintos cuadros clínicos requieren de distintas duraciones de terapia antibiótica, y tanto el exceso de días de tratamiento como su falta deben evitarse. Se requiere investigación en la búsqueda de estrategias más efectivas para prevenir las ITU recurrentes y en el desarrollo de nuevos antibióticos orales para las ITU resistentes.

Urinary tract infection, with its multiple clinical presentations, is one of the most common infectious diseases in both ambulatory and hospitalized patients. The urinalysis and urine culture should be used when appropriate. Asymptomatic bacteriuria should not be screened or treated, in part because of a concern for the selection of antibiotic resistant bacteria. The appropriate duration of treatment of urinary tract infection should be completed. Research is needed in newstrategies for prevention of recurrent urinary tract infections and development of new oral antibiotics for drug resistant bacteria.

Cistite glandular evoluindo com uropatia obstrutiva / Cystitis glandularis evolving with obstructive uropathy

Introdução: Cistite glandular é um processo proliferativo benigno e infrequente da mucosa vesical, caracterizado por proliferação do epitélio e, em alguns casos, formação de glândulas intestinais. Alterações metaplásticas na cistite glandular são bem documentadas na literatura, embora sua etiologia não seja totalmente esclarecida. Relato do caso: Relatamos um caso de cistite glandular em um paciente de 55 anos, apresentando sintomas miccionais irritativos e obstrutivos persistentes sem resposta à terapia com alfabloqueadores. Ultrassonografia evidenciou lesão vegetante no trígono vesical e o paciente foi submetido à ressecção endoscópica por duas vezes e evoluiu com ureterohidronefrose bilateral. Dado o extenso acometimento vesical e a persistência dos sintomas, o paciente foi submetido a cistoprostatectomia e neobexiga ileal com boa evolução pós-operatória. Discussão: Há duas formas de cistite glandular: típica e intestinal. A forma típica é a mais comum e a intestinal é marcada pela produção de mucina, mais frequentemente associada ao adenocarcinoma de bexiga. A maioria dos casos de cistite glandular é assintomática, sendo que os pacientes sitomáticos normalmente apresentam hematúria, sintomas urinários irritativos e típicos de cistite crônica. Há controvérsias sobre o tratamento precoce agressivo, sendo que vários estudos propõem a ressecção transuretral e o acompanhamento com biópsias.

Introduction: glandular cystitis is a benign proliferative process and infrequent mucosal bladder, characterized by proliferation of the epithelium and in some cases, formation of intestinal glands. Metaplásticas changes in glandular cystitis are well documented in the literature, although its etiology is not fully understood. Case report: A case of glandular cystitis in one patient of 55 years, with irritative and obstructive urinary symptoms persisted without response to therapy with alpha blockers. Ultrasonography revealed a vegetative lesion in the trigonal and the patient underwent endoscopic resection and twice progressed to bilateral ureterohidronefrose. Given the extensive bladder involvement and persistence of symptoms, the patient underwent ileal neobladder cistoprostatectomia and with good postoperative evolution. Discussion: There are two types of glandular cystitis: typical and intestinal tract. The typical form is the most common and is characterized by intestinal mucin production, most often associated with adenocarcinoma of the bladder. Most cases of glandular cystitis is asymptomatic, and patients usually present sitomáticos hematuria, urinary symptoms and typical of chronic cystitis. There is controversy over early aggressive treatment, and several studies suggest transurethral resection and follow-up biopsies.

Two case reports of emphysematous cystitis in two diabetic patients with related literature review

Emphysematous cystitis is a rare form of acute infection of the bladder is which most cases are seen in diabetic patients. Most infections are due to E.coli and Klebsiella species. Predisposing factors are diabetes mellitus, recurrent urinary tract infections, bladder outlet obstruction and neurogenic bladder. CT-scan is the most sensitive method of diagnosis that detects air whithin intramular of bladder that is pathogonomonic of the disease. In this case report we reported two cases of emphysematous cystitis. The first case was a 73 years old diabetic woman who was admitted due to acute renal failure after cholecystectomy. During hospitalization, after remission of renal function, she developed fever, abdominal pain, hematuria and progressive abdominal distention. In physical examination she had generalized abdominal tenderness with dominance in the lower abdomen without rebound tenderness which with observation of air in intramural bladder by CT-scan, diagnosis of emphysematous cystitis was confirmed and the patient was treated and improved. The second case was a 37 years old diabetic woman. She was refered to the hospital because of nausea, recurrent vomiting and abdominal pain. In physical examination she had severe hypotention, generalized abdominal tenderness that was dominant in the lower abdomen and abdominal mass in suprapubic area. Suspicious to emphysematous cystitis, pelvic CT-scan was ordered. By observation of air in intramural bladder, emphysematous cystitis was confirmed. Patient was treated with antibiotic, insertion of fouly catheter and was improved. Undiagnosing or delaying in initiating appropriate treatment can lead to peritonitis secondary to intraperitoneal perforation of the bladder, septisemia and ultimately death of the patient. Timely diagnosis and aggressive therapy are important for the survival of these patients

Eficacia clínica de fosfomicina trometamol 3g (monurol) en el tratamiento de la cistitis aguda / Clinical efficacy of fosfomycin trometamol 3g (monurol) in the treatment of acute cystitis

Objetivo del estudio: Comprobar la eficacia y buena tolerancia de fosfomicina trometamol 3g en dosis única en el tratamiento de la cistitis aguda. Diseño del estudio: Estudio clínico multicéntrico. Selección de pacientes: Mujeres entre 18 y 75 años que acudieron a la consulta ambulatoria con un cuadro clínico de cistitis aguda con test positivo determinado por la tira reactiva BM-test-LN sin antibioticoterapia previa. Con un máximo de 4 episodios de cistitis en el último año. Método: luego de aceptar voluntariamente participar en el estudio, cada paciente recibió un sobre de fosfomicina trometamol 3g como dosis única, citándolas 7 días después para evaluar la eficacia y tolerancia del fármaco, clínica y objetivamente por las tiras reactivas. Resultados: 90 médicos evaluaron 450 pacientes de su consulta ambulatoria. Predominó el grupo de 18 a 30 años (32.88 por ciento), 45 pacientes (10 por ciento) eran gestantes estando la mayoría (48.89 por ciento) en el primer trimestre del embarazo. El 15.55 por ciento padecían de otra enfermedad, siendo la HTA y diabetes las más frecuentes. La mayoría (61.55 por ciento) acudió por un cuadro recidivante, teniendo como principal molestia disuria (96 por ciento) y polaquiuria (91.77 por ciento). Todas las pacientes tenían nitritos en orina con más de 10-25 leucocitos según evaluación de la tira reactiva. Luego del tratamiento, 81.11 por ciento refirieron que desapareció la sintomatología entre el segundo y tercer día, en el 7.78 por ciento persistió el cuadro clínico. El 90.44 por ciento (407 pacientes) estuvieron asintomáticas y sin nitritos en orina, considerándose clínicamente curados; 31 pacientes (7 por ciento) tuvieron mejoría clínica y en 12 (2.66 por ciento) persistió el cuadro. En relación a la tolerancia, 45 pacientes (10 por ciento) refirieron molestias gastrointestinales leves y moderadas, que cedieron espontáneamente. Conclusión: fosfomicina trometamol 3g (monurol) en dósis única, demostró tener una buena eficacia clínica y tolerancia en el tratamiento de la cistitis aguda. Con desaparición de la sintomatología desde el 2do. día post-tratamiento, siendo de utilidad en embarazo independientemente de la edad gestacional.

Consideraçöes a respeito da cistite eosinofílica / Eosinophilic cystitis

Eosinophilic cystitis is a rare bladder disorder that was first reported in 1960 and can be diagnosed in children or adults. Its cause is unknown and usually presents with hematuria, supra pubic pain, sysuria and frequency. We have made an extensive literature review and we reported on 2 illustrative cases. The first case was a man presented with hematuria; a computed tomography, shown expansive process with a mass suggesting infiltration of the perivesical tissues. A biopsy was done and the pathological diagnosis was eosinophilic cystitis. The patient was treated with steroids. Later on, he had an episode of hematuria on the left ureteral orifice and a nephrouretectomy showed grade 2 urothelial carcinoma of the ureter. The second case is a child with neurogenic bladder due to myelomeningocele who had a cystostomy since the age of 5 months. Surgery was performed, including partial cystectomy with an ileal neobladder. The anatomopathological diagnosis was eosinophilic cystitis. The different classifications of eosinophilic cystitis were presented and discussed. The diagnosis of this entity can only be made by microscopic examination which shows mucosal edema or fibrosis, a polymorphous infiltrate rich in eosinophils and sometimes replacement of the bladder muscle by fibrotic tissue

Estudo multicentro da eficácia e segurança da lomefloxacina versus sulfametoxazol/trimetoprim no tratamento de cistite em mulheres / Multicenter study on the efficacy and safety of lomefloxacin versus trimethoprim and sulfamethoxazole in the treatment of lower urinary tract infection in women

A lomeflomexacina (maxaquim), uma nova quinolona difluorada, e o trimetoprim/sulfametoxazol (bactrim) foram comparados no tratamento de mulheres adultas com infecçöes urinárias simples. O estudo foi randomizado, prospectivo, controlado e realizado em seis centros. Um total de 57 pacientes foram estudados: 30 em tratamento com Bactrim e 27 em tratamento com Maxaquim. As pacientes receberam 400mg de lomefloxacina via oral, de 12/12 horas, por três dias ou 160mg/800mg trimetoprim/sulfametoxazol via oral, de 12/12 horas por sete dias. Eschericia coli, Klebsiella e Proteus mirabilis foram os patogenos mais frequentemente isolados. Cinco a nove dias pós-terapia, cura bacteriológica foi verificada em 92,6 por cento das pacientes tratadas com lomefloxacina e em 90 por cento das pacientes do grupo do trimetoprim/sulfametoxazol. Sucesso clínico foi constatado em 96,3 por cento das pacientes no grupo da lomefloxacina e em 96,7 por cento das pacientes trimetoprim/sulfametaxol. Efeitos adversos, provavelmente relacionados com o tratamento, foram nauseas, desconforto gástrico de moderada intensidade e mal estar com nauseas de forte intensidade para o grupo trimetoprim/sulfametoxazol e epigastralgia de fraca intensidade para o grupo lomefloxacina. O tratamento único com lomefloxacina foi eficaz e bem tolerado no tratamento das infeçöes do trato urinário causadas por patogenos sensíveis a esta droga

Estudo aberto e prospectivo, para avaliar a efetividade e a segurança da ciprofloxacina no tratamento da cistite aguda näo complicada / Prospective and open trial to assess the efficacy and safety of ciprofloxacin in the treatment of acute uncomplicated cystitis

A eficacia e a segurança da ciprofloxina no tratamento da cistite aguda näo complicada foi avaliada neste estudo aberto e prospectivo. Foram analisados 68 pacientes adultos com relaçäo aos sinais e sintomas de infecçäo urinária (disuria, estranguria, polaciuria, urgencia miccional, urina escura e dor suprapubica) e em relaçäo a urocultura. Todos receberam ciprofloxacina (250 mg a cada 12 horas) por via oral durante três dias, sendo avaliados no primeiro, sétimo e trigésimo dia (pós-terapia). Oito pacientes apresentaram efeitos adversos de intensidade leve a moderada. Em 90,2 por cento dos pacientes houve desaparecimento dos sinais e sintomas de infecçäo. A cura bacteriológica foi constatada em 95,1 por cento dos pacientes. Concluimos que a ciprofloxacina e exteramamente eficaz e segura no tratamento da cistite aguda näo complicada

Tratamento de cistites agudas com antibioticoterapia em dose unica: estudo comparativo entre fosfomicina trometamol e ampicilina / Single dose antibiotic therapy for acute cystitis: comparison between Phosphomycin-Trometanol and ampicilin

Cistites agudas tem sido tratadas com sucesso empregando-se dose unica de antibioticos ou quimioterapicos. Foram estudadas 27 pacientes portadoras de cistite aguda complicada, tratadas de forma randomizada com dose unica de 3 g de fosfomicina-trometamol ou ampicilina. A cura bacteriologica, com negativaçao da cultura de urina, ocorreu em 84,6 por cento e 50,0 por cento das pacientes tratadas com fosfomicina-trometamol e com ampicilina, respectivamente. Efeitos colaterais, em geral, transitorios e de pouca intensidade, foram observados em 15,4 por cento dos casos que receberam fosfomicina-trometamol e em 35,7 por cento daqueles tratados com ampicilina. De acordo com estas observaçoes, o emprego de doses unicas de fosfomicina-trometamol foi eficiente no tratamento de cistites agudas, com resultados superiores aos observados com a utilizaçao de ampicilina

Cistite intersticial - experiencia de 12 casos tratados com dimityl-sulfoxide (DMSO) / Interstitial cystitis: experience with twelve patients treated with dimetyl-sulfoxide (DMSO)

Os autores apresentam sua experiencia no tratamento da cistite intersticial com Dimetyl-Sulfoxide (DMSO). Doze pacientes com cistite intersticial diagnosticada atraves da historia, aspecto cistoscopico e biopsia da mucosa vesical foram tratados com DMSO. O desaparecimento dos sintomas verificou-se em 83 por cento das pacientes que completaram o tratamento, nao sendo constatados efeitos colaterais significativos

Estudio multicéntrico abierto no comparativo de pefloxacina en dósis única de 800 mg en el tratamiento de uretrocistitis infecciosa, realizado en México / An open, multicentric, non-comparative study of Pefloxazyne in a single 800 mg dose, in the treatment of infectious urethrocystitis, performed in México

Se realizó un estudio multicéntrico abierto no comparaivo en el que participaron 18 reconocidos urólogos de la República Mexicana, de las ciudades de Monterey, Guadalajara, Toluca, León y el Distrito Federal. Se valoró la eficacia antimicrobiana y la tolerancia de pefloxacina en dosis única de dos comprimidos de 400 mg. en el tatamiento de uretrocistitits infecciosa, previa revisión del protocolo de investigación clínica por parte de los investigadores participantes con la finalidad de unificar criterior para su valoración posterior

Dimetilsulfoxido en la cistitis crónica sintomática / Dimetilsulfoxide in the symptomatic chronic cystitis

Se presentan 17 pacientes portadores de cistitis crónica sintomática tratados con D.M.S.O. endovesical. Comprobamos mejoría clínica, de la capacidad vesical y disminución de la frecuencia miccional después del tratamiento. Comunicamos la aparición de una cistitis xantomatosa severa posterior al uso del D.M.S.O.

Cistite hemorrágica induzida por ciclo-fosfamida na nefrite lúpica: relato de caso / Hemorrhagic cystitis induced by cyclophosphamide in lupus nephritis: report of a case

Os autores descrevem o caso de uma paciente de 20 anos, portadora de nefrite lúpica, que desenvolveu quadro de cistite hemorrágica após uso oral de ciclofosfamida por seis meses, na dose de 100mg/dia. A paciente apresentou-se com hematúria macroscópica e dor abdominal importante; a cistoscopia revelou sangramento difuso e ulceraçöes de epitélio vesical. Tratamento conservador, com irrigaçäo vesical contínua com sulfato de alumínio, mostrou-se insuficiente, por causa da constante obstruçäo da sonda de Folley. Analgesia epidural com morfina permitiu manipulaçäo eficaz da sondagem vesical e o sangramento desapareceu completamente em cinco dias. Os autores discutem as causas da hematúria e os outros tratamentos utilizados nestes casos

Instilaciones vesicales con nitrato de Ag o argyrol en uretrotrigonitis: efecto real o placebo? / Intravesical silver nitrate instillations in urethrotrigonitis: real effect or placebo?

Se estudian 45 pacientes diagnosticadas como "uretrotrigonitis", en quienes se evalúa en doble ciego el tratamiento de instilación vesical con nitrato de plata versus placebo. No se encuentran diferencias entre ambos tratamientos, habiendo observado un buen resultado global subjetivo en el 55%. Tampoco se encuentra relación entre la mejoría subjetiva y la endoscópica

Cistitis intersticial: diagnóstico y tratamiento / Interstitial cystitis: diagnosis and treatment

Se presenta una experiencia de 26 casos de cistitis intersticial. Se tratan 22 casos: 16 con terapia médica (D.M.S.O. y distensión vesical), 6 con sigmoidocistoplastía. El tratamiento falló solamente en un caso. Se destacan uso de endoscopia y distensión vesical bajo anestesia general. El D.M.S.O. se mantuvo en vejigas por un tiempo más prolongado que el citado en la literatura

Infecçäo do trato urinário (cistite bacteriana): proposta terapêutica da fase aguda / Urinary tract infection (bacterial cystitis): therapeutic proposal of acute stage

Estudou-se, no Setor de Nefrologia da Disciplina de Pediatria da Faculdade de Medicina da UFJF, 70 casos de I.T.U. baixa (cistite). Estudados em protocolo especial, mostraram a prevalência no sexo masculino, sendo neste estudo a idade média dos pacientes 5.8 anos. Preconizaram-se três esquemas terapêuticos. Os pacientes com uropatias baixas näo responderam a nenhum tratamento proposto. Assim sendo, enfatiza-se a necessidade de estudos radiológico e/ou endoscópico dos pacientes näo responsivos e acompanhamento daqueles que responderam à terapêutica