Effects of supplementation with vitamins C and E on the acute inflammatory response in Piaractus mesopotamicus / Efeitos da suplementação com vitaminas C e E na resposta inflamatória aguda em Piaractus mesopotamicus

Vitamins C and E are potent antioxidants that reduces the harmful effects of stress in several species including fish. In this study, it was evaluated the effect of vitamins C, E and their combination in the acute aerocystitis induced by inactivated Aeromonas hydrophila in pacu. 288 fish were distributed into 4 groups supplemented for 90 days: G1-control; G2- supplemented with 500 mg of Vitamin C; G3-supplemented with 500 mg of Vitamin E; G4-supplemented with 500 mg of Vitamin C + 500 mg of Vitamin E. The fish were divided in three groups, the first was not inoculated; second were inoculated in the swim bladder with 3 x 109 CFU of inactivated A. hydrophila and the last one with saline. The inflammatory exudate was collected from the swim bladder for assessment of cellular component and cytochemistry. The results showed higher accumulation of leukocytes in fish inoculated with bacteria. Cytochemistry was effective identifying thrombocytes, lymphocytes, macrophages and, granulocytes present in the exudate. It was also observed fish that received supplementation with vitamins presented higher accumulation of total cells in the exudate with a predominance of lymphocytes and thrombocytes. These results suggested that supplementation with vitamins improved the immunological responses.

As vitaminas C e E são potentes antioxidantes que reduzem os efeitos nocivos do estresse em várias espécies, incluindo peixes. Neste estudo, avaliou-se o efeito das vitaminas C, E e sua combinação na aerocistite aguda induzida por Aeromonas hydrophila inativada em pacu. 288 peixes foram distribuídos em 4 grupos suplementados por 90 dias: G1-controle; G2- suplementado com 500 mg de Vitamina C; G3-suplementado com 500 mg de Vitamina E; G4-suplementado com 500 mg de Vitamina C + 500 mg de Vitamina E. Os peixes foram divididos em três grupos, o primeiro não foi inoculado; o segundo foi inoculado na bexiga natatória com 3 x 109 UFC de A. hydrophila inativada e a última com soro fisiológico. O exsudato inflamatório foi coletado da bexiga natatória para avaliação do componente celular e citoquímica. Os resultados mostraram maior acúmulo de leucócitos nos peixes inoculados com a bactéria. A citoquímica foi eficaz na identificação de trombócitos, linfócitos, macrófagos e granulócitos presentes no exsudato. Também foi observado que os peixes que receberam suplementação com vitaminas apresentaram maior acúmulo de células totais no exsudato com predominância de linfócitos e trombócitos. Esses resultados sugeriram que a suplementação com vitaminas melhorou as respostas imunológicas.

Cystitis in a bitch with chronic kidney disease caused by multidrug-resistant Escherichia coli

Background: In dogs with bacterial cystitis that is resistant to multiple antibiotics, resulting from repeated infections andantimicrobial administration, especially if the dog has impaired renal function and the induction of systemic side effectsby intravenous or oral administration is a concern, intravesical instillation of antibiotics might represent an alternativetreatment option. In human and veterinary medicine, a number of studies showed intravesical instillation of antibiotics iseffective for the therapy multidrug-resistant bacterial urinary tract infection (UTI). This report firstly illustrates successfulintravesical meropenem treatment of a UTI caused by multidrug-resistant Escherichia coli with no systemic side effectsin dog with chronic kidney disease (CKD).Case: A 15-year-old spayed female Maltese was presented with recurrent bacterial cystitis. The risk factors for the recurrent UTI were spinal cord injury and CKD which had been managed for 1 year. Ultrasound-guided cystocentesis wasperformed to obtain a urine sample for urinalysis, bacteriologic culture, and antibiotic susceptibility testing. Bacterialcystitis caused by multidrug-resistant Escherichia coli was diagnosed on the basis of bacterial culture, and antimicrobialsusceptibility testing. Because the dog had CKD, reducing the clearance of meropenem, intravesical instillation of antibiotics was initiated. The intravesical instillation process consisted of the emptying of the urinary bladder, infusion of adiluted meropenem solution (8.5 mg/kg diluted in 20 mL of saline solution) into the bladder through a urethral catheter,and retention of the meropenem solution in the bladder for 1 h, and its removal. The procedure was repeated every 8 h. Onday 8 of the intravesical instillation therapy, bactereologic culture yielded a growth of E. coli (50,000 CFUs/mL), whichwas less than previously obtained. the concentration of the meropenem solution...(AU)

Cystitis in a bitch with chronic kidney disease caused by multidrug-resistant Escherichia coli

Background: In dogs with bacterial cystitis that is resistant to multiple antibiotics, resulting from repeated infections andantimicrobial administration, especially if the dog has impaired renal function and the induction of systemic side effectsby intravenous or oral administration is a concern, intravesical instillation of antibiotics might represent an alternativetreatment option. In human and veterinary medicine, a number of studies showed intravesical instillation of antibiotics iseffective for the therapy multidrug-resistant bacterial urinary tract infection (UTI). This report firstly illustrates successfulintravesical meropenem treatment of a UTI caused by multidrug-resistant Escherichia coli with no systemic side effectsin dog with chronic kidney disease (CKD).Case: A 15-year-old spayed female Maltese was presented with recurrent bacterial cystitis. The risk factors for the recurrent UTI were spinal cord injury and CKD which had been managed for 1 year. Ultrasound-guided cystocentesis wasperformed to obtain a urine sample for urinalysis, bacteriologic culture, and antibiotic susceptibility testing. Bacterialcystitis caused by multidrug-resistant Escherichia coli was diagnosed on the basis of bacterial culture, and antimicrobialsusceptibility testing. Because the dog had CKD, reducing the clearance of meropenem, intravesical instillation of antibiotics was initiated. The intravesical instillation process consisted of the emptying of the urinary bladder, infusion of adiluted meropenem solution (8.5 mg/kg diluted in 20 mL of saline solution) into the bladder through a urethral catheter,and retention of the meropenem solution in the bladder for 1 h, and its removal. The procedure was repeated every 8 h. Onday 8 of the intravesical instillation therapy, bactereologic culture yielded a growth of E. coli (50,000 CFUs/mL), whichwas less than previously obtained. the concentration of the meropenem solution...

Cistite em um felino: relato de caso

A doença do trato urinário inferior de felinos é importante na rotina clínica, acometendo bexiga e/ou uretra, comprometendo o bem estar. Objetivou-se relatar um caso de cistite em felino. Felino, castrado foi atendido, apresentando polaquiúria e inquietação. Foram solicitados exames complementares. A urinálise mostrou: hematúria, leucocitúria, bacteriúria e proteinúria. Os níveis de creatinina e uréia sérica apresentavam-se normais. O hemograma não revelou alteração e, a ultrassonografia, mostrou presença de cristais. Conclui-se que a cistite induz alterações clínicas e laboratoriais no animal, principalmente na urinálise. O diagnóstico precoce e terapêutico adequado foi essencial para evitar o agravamento do quadro e, futuras complicações.

Feline lower urinary tract disease is important in the clinical routine, affecting bladder and / or urethra, compromising well-being. The objective of this study was to report a case of cat cystitis. Feline, castrated was attended, presenting polaquiúria and restlessness. Further examinations were ordered. Urinalysis showed: hematuria, leukocyturia, bacteriuria, proethinuria. Serum creatinine and urea levels were normal. The hemogram showed no alteration and, on ultrasonography, showed crystals. It is concluded that cystitis induces clinical and laboratory changes in the animal, mainly urinalysis. Adequate early diagnosis and therapy were essential to avoid aggravation of the condition and future complications.

Cistite em um felino: relato de caso

A doença do trato urinário inferior de felinos é importante na rotina clínica, acometendo bexiga e/ou uretra, comprometendo o bem estar. Objetivou-se relatar um caso de cistite em felino. Felino, castrado foi atendido, apresentando polaquiúria e inquietação. Foram solicitados exames complementares. A urinálise mostrou: hematúria, leucocitúria, bacteriúria e proteinúria. Os níveis de creatinina e uréia sérica apresentavam-se normais. O hemograma não revelou alteração e, a ultrassonografia, mostrou presença de cristais. Conclui-se que a cistite induz alterações clínicas e laboratoriais no animal, principalmente na urinálise. O diagnóstico precoce e terapêutico adequado foi essencial para evitar o agravamento do quadro e, futuras complicações. (AU)

Feline lower urinary tract disease is important in the clinical routine, affecting bladder and / or urethra, compromising well-being. The objective of this study was to report a case of cat cystitis. Feline, castrated was attended, presenting polaquiúria and restlessness. Further examinations were ordered. Urinalysis showed: hematuria, leukocyturia, bacteriuria, proethinuria. Serum creatinine and urea levels were normal. The hemogram showed no alteration and, on ultrasonography, showed crystals. It is concluded that cystitis induces clinical and laboratory changes in the animal, mainly urinalysis. Adequate early diagnosis and therapy were essential to avoid aggravation of the condition and future complications.(AU)

Terapias para cistite idiopática felina: revisão de literatura / Therapies for feline idiopathic cystitis: review

A cistite idiopática felina é uma doença inflamatória estéril crônica que não esta limitada somente as anormalidades relacionadas à bexiga e uretra. Sua fisiopatogenia ainda não está totalmente esclarecida e é a causa de base mais comum em gatos com Doença do Trato Urinário Inferior dos Felinos (DTUIF). Pode ser desencadeada por situações estressantes, divididas em: comportamento social, como disputa territorial, estado físico, como imunossupressão e ambiental, como alterações na rotina e ambiente do gato. É necessária uma ótima comunicação ao tutor sobre a necessidade de medidas de manejo a longo prazo, para auxiliar no bem-estar do paciente, uso de analgésicos, enriquecimento ambiental e em alguns casos pode ser necessário o uso outros fármacos para amenizar os quadros agudos ou crônicos. A Modificação Ambiental Multimodal (MEMO) por ser uma abordagem multifatorial, é a mais indicada pois melhora a qualidade de vida e bem-estar do gato, e deve ser utilizada antes da administração de fármacos. Juntamente a esta terapia, indica-se a introdução de dieta úmida com o objetivo de aumentar a ingestão hídrica, e consequentemente aumentar a diluição da urina. Medicamentos devem ser administrados somente quando todas as outras terapias não obtiveram uma resposta positiva. Esta revisão bibliográfica tem como objetivo descrever as terapias que podem ser utilizados na cistite idiopática felina.

Feline idiopathic cystitis (FIC) is a chronic inflammatory disease that is not limited only to abnormalities related to the bladder and urethra. Its pathophysiology is still not fully understood and is the most common cause in cats with feline lower urinary tract disease (FLUTD). It can be triggered by stressful situations, divided into: social behavior, such as territorial dispute, physical state, such as immunosuppression and environmental, such as changes in the cat’s routine and environment. Adequate communication to the tutor is needed on the need for long-term management measures to assist patient well-being, use of analgesics, environmental enrichment, and in some cases it may be necessary to use other drugs to ameliorate acute or chronic diseases. The Multimodal Environmental Modification (MEMO), because it is a multifactorial approach, is the most indicated because it improves the quality of life and well-being of the cat, and should be used before the administration of drugs. Along with this therapy, the introduction of wet diet is indicated with the aim of increasing water intake, and consequently increasing the dilution of urine. Medications should be given only when all other therapies have not received a positive response. This literature review aims to describe the therapies that can be used in feline idiopathic cystitis.

Terapias para cistite idiopática felina: revisão de literatura / Therapies for feline idiopathic cystitis: review

A cistite idiopática felina é uma doença inflamatória estéril crônica que não esta limitada somente as anormalidades relacionadas à bexiga e uretra. Sua fisiopatogenia ainda não está totalmente esclarecida e é a causa de base mais comum em gatos com Doença do Trato Urinário Inferior dos Felinos (DTUIF). Pode ser desencadeada por situações estressantes, divididas em: comportamento social, como disputa territorial, estado físico, como imunossupressão e ambiental, como alterações na rotina e ambiente do gato. É necessária uma ótima comunicação ao tutor sobre a necessidade de medidas de manejo a longo prazo, para auxiliar no bem-estar do paciente, uso de analgésicos, enriquecimento ambiental e em alguns casos pode ser necessário o uso outros fármacos para amenizar os quadros agudos ou crônicos. A Modificação Ambiental Multimodal (MEMO) por ser uma abordagem multifatorial, é a mais indicada pois melhora a qualidade de vida e bem-estar do gato, e deve ser utilizada antes da administração de fármacos. Juntamente a esta terapia, indica-se a introdução de dieta úmida com o objetivo de aumentar a ingestão hídrica, e consequentemente aumentar a diluição da urina. Medicamentos devem ser administrados somente quando todas as outras terapias não obtiveram uma resposta positiva. Esta revisão bibliográfica tem como objetivo descrever as terapias que podem ser utilizados na cistite idiopática felina.(AU)

Feline idiopathic cystitis (FIC) is a chronic inflammatory disease that is not limited only to abnormalities related to the bladder and urethra. Its pathophysiology is still not fully understood and is the most common cause in cats with feline lower urinary tract disease (FLUTD). It can be triggered by stressful situations, divided into: social behavior, such as territorial dispute, physical state, such as immunosuppression and environmental, such as changes in the cats routine and environment. Adequate communication to the tutor is needed on the need for long-term management measures to assist patient well-being, use of analgesics, environmental enrichment, and in some cases it may be necessary to use other drugs to ameliorate acute or chronic diseases. The Multimodal Environmental Modification (MEMO), because it is a multifactorial approach, is the most indicated because it improves the quality of life and well-being of the cat, and should be used before the administration of drugs. Along with this therapy, the introduction of wet diet is indicated with the aim of increasing water intake, and consequently increasing the dilution of urine. Medications should be given only when all other therapies have not received a positive response. This literature review aims to describe the therapies that can be used in feline idiopathic cystitis.(AU)

A cistite idiopática felina: o que devemos saber / Feline idiopathic cystitis: what we sould know

A cistite idiopática felina (CIF) é uma enfermidade que comumente afeta gatos domiciliados, sendo uma das principais causas da doença do trato urinário inferior (DTUIF). O objetivo dessa revisão de literatura é abordar os aspectos gerais sobre a CIF, dados atuais sobre a epidemiologia, fisiopatologia, formas de diagnóstico e terapia, indicados para essa patologia que tanto acomete os felinos. As causas da CIF são pouco conhecidas e sua fisiopatologia é incerta, envolvendo associação entre estímulos estressantes e a resposta do eixo hipotálamo-hipófise-adrenal e sistema nervoso simpático em gatos susceptíveis. Durante o desenvolvimento do quadro clínico a CIF caracteriza-se pela presença de sinais clínicos recorrentes como periúria, hematúria, disúria, estrangúria, polaquiúria, anúria, anorexia, hiporexia, êmese, apatia, diarreia, isolamento, lambedura excessiva na região perineal e abdome caudal, bem como a remoção de pelos da cauda. O diagnóstico é realizado através de anamnese, sinais clínicos, investigação detalhada através de exames laboratoriais e de imagem que possibilitem a exclusão de outras causas de DTUIF. O tratamento tem como objetivo reduzir a gravidade dos sinais clínicos e aumentar o intervalo entre a ocorrência dos quadros clínicos e, devido à sua fisiopatologia multifatorial, torna-se interessante realizar um tratamento multimodal. Assim, a terapêutica torna-se variável conforme os sinais clínicos apresentados pelo paciente, visando principalmente, o restabelecimento do fluxo urinário e analgesia. Além disso, devem ser realizadas melhores adaptações ao manejo do animal, bem como a adoção de medidas que aumentem a ingestão hídrica e minimizar fatores estressantes que possam contribuir para recorrência do quadro clínico.

Feline idiopathic cystitis (FIC) is a common disease found in domiciled cats, being one of the main causes of lower urinary tract disease (FLUTD). The purpose of this review is to address the general aspects of CIF, current data on the indicated epidemiology, pathophysiology, diagnosis and therapy indicated for this pathology that affects both felines. Its causes are poorly understood and its pathophysiology is uncertain, involving the association between stressful stimuli and the response of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system in susceptible cats. During the development of the disease, FIC is characterized by the presence of recurrent clinical signs - periuria, hematuria, dysuria, strangury, polaquiuria, anuria, anorexia, hyporexia, emesis, apathy, diarrhea, isolation, excessive licking in the perineal region and caudal abdomen , as well as the removal of tail hairs. The diagnosis is made through anamnesis, clinical signs and detailed investigation through laboratorial and imaging exams that allow the exclusion of other causes of LUTD. The treatment aims to reduce the severity of clinical signs and increase the interval between the occurrence of clinical conditions and, due to its multifactor pathophysiology, it is interesting to perform a multimodal treatment. Thus, the therapy is variable according to the clinical signs presented by the patient aiming, mainly, the reestablishment of the urinary flow and analgesia. In addition, better adaptations to animal management should be made such as the adoption of measures that increase water intake and minimize stressors that may contribute to recurrence of the clinical picture. Keywords: Cat, lower urinary tract disease, stress, multimodal treatment.

A cistite idiopática felina: o que devemos saber / Feline idiopathic cystitis: what we sould know

A cistite idiopática felina (CIF) é uma enfermidade que comumente afeta gatos domiciliados, sendo uma das principais causas da doença do trato urinário inferior (DTUIF). O objetivo dessa revisão de literatura é abordar os aspectos gerais sobre a CIF, dados atuais sobre a epidemiologia, fisiopatologia, formas de diagnóstico e terapia, indicados para essa patologia que tanto acomete os felinos. As causas da CIF são pouco conhecidas e sua fisiopatologia é incerta, envolvendo associação entre estímulos estressantes e a resposta do eixo hipotálamo-hipófise-adrenal e sistema nervoso simpático em gatos susceptíveis. Durante o desenvolvimento do quadro clínico a CIF caracteriza-se pela presença de sinais clínicos recorrentes como periúria, hematúria, disúria, estrangúria, polaquiúria, anúria, anorexia, hiporexia, êmese, apatia, diarreia, isolamento, lambedura excessiva na região perineal e abdome caudal, bem como a remoção de pelos da cauda. O diagnóstico é realizado através de anamnese, sinais clínicos, investigação detalhada através de exames laboratoriais e de imagem que possibilitem a exclusão de outras causas de DTUIF. O tratamento tem como objetivo reduzir a gravidade dos sinais clínicos e aumentar o intervalo entre a ocorrência dos quadros clínicos e, devido à sua fisiopatologia multifatorial, torna-se interessante realizar um tratamento multimodal. Assim, a terapêutica torna-se variável conforme os sinais clínicos apresentados pelo paciente, visando principalmente, o restabelecimento do fluxo urinário e analgesia. Além disso, devem ser realizadas melhores adaptações ao manejo do animal, bem como a adoção de medidas que aumentem a ingestão hídrica e minimizar fatores estressantes que possam contribuir para recorrência do quadro clínico.(AU)

Feline idiopathic cystitis (FIC) is a common disease found in domiciled cats, being one of the main causes of lower urinary tract disease (FLUTD). The purpose of this review is to address the general aspects of CIF, current data on the indicated epidemiology, pathophysiology, diagnosis and therapy indicated for this pathology that affects both felines. Its causes are poorly understood and its pathophysiology is uncertain, involving the association between stressful stimuli and the response of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system in susceptible cats. During the development of the disease, FIC is characterized by the presence of recurrent clinical signs - periuria, hematuria, dysuria, strangury, polaquiuria, anuria, anorexia, hyporexia, emesis, apathy, diarrhea, isolation, excessive licking in the perineal region and caudal abdomen , as well as the removal of tail hairs. The diagnosis is made through anamnesis, clinical signs and detailed investigation through laboratorial and imaging exams that allow the exclusion of other causes of LUTD. The treatment aims to reduce the severity of clinical signs and increase the interval between the occurrence of clinical conditions and, due to its multifactor pathophysiology, it is interesting to perform a multimodal treatment. Thus, the therapy is variable according to the clinical signs presented by the patient aiming, mainly, the reestablishment of the urinary flow and analgesia. In addition, better adaptations to animal management should be made such as the adoption of measures that increase water intake and minimize stressors that may contribute to recurrence of the clinical picture. Keywords: Cat, lower urinary tract disease, stress, multimodal treatment.(AU)

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.

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

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.

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.

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. .

Computed tomography scan in supine and prone positions: an alternative method to detect intramural gas in emphysematous cystitis and to evaluate efficacy after adjuvant continuous intravesical irrigation treatment.

OBJECTIVE: To evaluate the efficacy of continuous intravesical irrigation with saline plus amikacin as adjuvant therapy and to evaluate the computed tomography (CT) scan in supine and prone positions (CystoCT scan) as an alternative diagnostic and evaluation method of intramural gas in emphysematous cystitis (EC) before and after treatment. METHODS: Consecutive patients with a diagnosis of EC who were hospitalized between March 2006 and January 2011 were investigated. The diagnosis was made by CystoCT scan. Treatment consisted of intravenous antibiotics, control of concomitant diseases, and placement of a 3-way urinary catheter for continuous irrigation of 500 mg of amikacin diluted in 1 l of saline given on days 0, 3, and 7. Treatment was considered successful when there was an absence of gas in the bladder wall, the urine culture was negative, there was clinical improvement, and there was an absence of toxicity. RESULTS: Eleven patients were hospitalized with a diagnosis of EC during the study period. Four were excluded from the study, 2 due to the lack of confirmation of the diagnosis with the CystoCT scan. Treatment was successful in all patients; for 6 (86%) this was achieved in 3 days and for 1 (14%) in 7 days. No toxicity was reported. CONCLUSIONS: Continuous intravesical irrigation with saline plus amikacin as adjuvant treatment of EC is an inexpensive, effective, and safe tool that might help conventional treatment and provide a rapid recovery. The CystoCT scan is an alternative method to diagnose and evaluate intramural gas in EC patients. These findings should be challenged in a randomized, multi-centre, placebo-controlled clinical trial.

Vascular therapy for radiation cystitis.

PURPOSE: The underlying pathology of radiation cystitis is cellular and vascular damage followed by increased fibrosis and inflammation. This study was to determine if neovascular-promoting therapy could reduce the pathological changes in the bladder wall associated with pelvic irradiation. METHODS: Adult female Lewis inbred rats were irradiated with a single dose of 20 Gy directed at their bladder. Four weeks later, 30 rats were divided equally into one of three treatment groups for bladder wall injection of: (1) PBS (Control); (2) PBS containing 50 ng vascular endothelial growth factor (VEGF (165)); or (3) PBS containing 1 × 10(6) rat endothelial cells (EC). Age-matched non-irradiated rats (n = 10) served as untreated controls. At either 1.5 or 3 months following radiation, bladders were analyzed for collagen deposition using Masson's Trichrome staining of collagen and muscle and vascularization using Von Willebrand factor staining of ECs. Quantitative-PCR was used to examine markers of angiogenesis, hypoxia, and fibrosis. RESULTS: The collagen/muscle ratio was doubled in the control group 3 months post-irradiation (P < 0.05 vs. non-irradiated bladders). Both ECs and VEGF inhibited increases in collagen content (P < 0.05 vs. control). Similarly, irradiation reduced bladder wall vessel counts compared to non-irradiated controls (P < 0.05) and both ECs and VEGF maintained vessel counts similar to that of non-irradiated controls (P < 0.05). PCR analysis showed a higher expression of neovascular markers (CD31, KDR) in the EC and VEGF groups compared to non-irradiated controls (P < 0.05). CONCLUSIONS: Angiogenesis therapy may be useful in the prevention and/or treatment of the underlying pathology of radiation cystitis.

[Management of hemorrhagic radiation cystitis with hyperbaric oxygen therapy]. / Tratamiento de la cistitis actínica hemorrágica mediante oxigenoterapia hiperbárica.

INTRODUCTION AND OBJECTIVES: hemorrhagic cystitis (HC) after pelvic radiotherapy occurs in 2-8% of patients. A variety of treatments have been described, most of them with uncertain results. We assessed the efficacy of hyperbaric oxygen therapy (HBOT) in HC cases. PATIENTS AND METHODS: retrospective analysis of patients with HC after pelvic radiotherapy receiving HBOT at our center between January 2002 and January 2010. Our protocol included 40 sessions of HBOT in a multiplace hyperbaric chamber with 90minutes of 100% oxygen breathing at 2.2 atm. Success was evaluated in terms of total or partial stop of bladder bleeding. Telephone follow-up was updated at the time of submission in all cases. RESULTS: twenty-five patients were treated (21 male, 4 female); the mean age was 66.7 years. Twenty men were irradiated for prostate cancer and one for bladder cancer. Three women had cervix cancer and one endometrial cancer. In all cases previous conservative treatment had failed and HBOT was considered only after other measures failed. All the patients responded to HBOT and none recurred after end of treatment at a mean follow-up of 21.2 months. There were no serious complications. CONCLUSION: HBOT is a highly effective and safe, non-invasive therapy for HC secondary to pelvic radiation; it should be considered as first line alternative in these difficult cases.