Atorvastatin-induced hemorrhagic cystitis: a case report

The first case of hemorrhagic cystitis due to atorvastatin for treatment of hyperlipidemia is reported. Hematuria resolved spontaneously with discontinuation of the drug.     

Pyelolymphatic backflow complicating acute hemorrhagic cystitis: a case report]

The clinical course of a case of pyelolymphatic backflow complicated with acute hemorrhagic cystitis is reported. The patient was a 19-year-old woman. She had disturbed passage in the intravesical ureter due to acute hemorrhagic cystitis caused by adenovirus. Pyelolymphatic backflow occurred because of increased pelvic pressure.     

Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis

Study Type – Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Hemorrhagic cystitis (HC) is a relatively rare bladder disease with a complex etiology. With the growing number of patients with pelvic radiation therapy, incidence of this disease has risen considerably. Although treatments like hyperbaric oxygen (HBO) had some benefit to improve the symptoms, the optimal treatment of this disease still remains a tough problem. We reported our experience of intravesical hyaluronic acid (HA) and HBO in treating HC and the results seemed interesting. Intravesical HA is easier to do and well tolerated, and it showed a sustained decrease of bladder bleeding, pelvic pain and frequency of voiding for at least 12 months. We suggest it as an alternative and potential way in treating HC.

OBJECTIVE

• ? To compare the efficacy of intravesical hyaluronic acid (HA) instillation and hyperbaric oxygen (HBO) in the treatment of radiation‐induced haemorrhagic cystitis (HC).

PATIENTS AND METHODS

• ? In total 36 patients who underwent radiotherapy for their pelvic malignancies and subsequently suffered from HC were randomly divided into an HA group and an HBO group.
• ? Symptoms of haematuria, frequency of voiding and the visual analogue scale of pelvic pain (range 0–10) were evaluated before and after the treatment with follow‐up of 18 months.

RESULTS

• ? All patients completed this study and no obvious side effects of intravesical HA were recorded.
• ? The improvement rate showed no statistical difference between the two groups at 6, 12 and 18 months after treatment.
• ? Decrease of frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy.
• ? The improvement in the visual analogue scale remained significant in both groups for 18 months.

CONCLUSIONS

• ? Intravesical instillation of HA was as effective in treating radiation‐induced HC as HBO.
• ? It is well tolerated and resulted in a sustained decrease of bladder bleeding, pelvic pain and frequency of voiding for at least 12 months.

     

Management of hemorrhagic radiation cystitis with hyperbaric oxygen therapy

Introduction and objectiveshemorrhagic 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 methodsretrospective 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 90 minutes 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.Resultstwenty-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.ConclusionHBOT 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.     

Successful treatment of radiation cystitis with hyperbaric oxygen

This report describes the results of hyperbaric oxygen therapy in 10 patients with radiation-induced cystitis. Severe macroscopic hematuria was present in all patients and was resistant to current therapy. Previously 8 patients had been treated for bladder carcinoma and 2 for prostatic carcinoma with 60 Gy radiotherapy. Hyperbaric oxygen therapy consisted of 20 sessions of 100% oxygen inhalation at 3 bar pressure for 90 min. In 6 patients the macroscopic hematuria stopped completely and it decreased in the other patients. These 4 patients had recurrent or residual bladder malignancies.     

双极等离子电切联合吡柔比星膀胱灌注治疗腺性膀胱炎23例报告

目的评价经尿道双极等离子电切（PK）联合膀胱内灌注吡柔比星（THP）治疗腺性膀胱炎23例的疗效。方法 23例中,男6例,女17例;年龄32~68岁,平均（47.54±10.24）岁。临床症状主要表现为尿频、尿急14例,伴血尿8例、排尿困难4例、不同程度的下腹部隐痛、不适9例。23例患者均行膀胱镜检查及组织活检证实为腺性膀胱炎。采用硬膜外麻醉下经尿道病变组织电切,术后1周开始膀胱灌注吡柔比星30 mg＋生理盐水50 mL,保留2 h,每周1次,连续8次,之后每月1次至术后1年。结果 23例均获随访,时间6~24个月。18例治愈,4例好转,1例无效,其中2例分别于术后6、16个月复发。23例均无恶变。结论 PK联合膀胱灌注吡柔比星治疗可显著改善腺性膀胱炎症状,是一种有效可行的治疗方法。     

An unusual complication of silver nitrate treatment of hemorrhagic cystitis: case report

A patient with severe cyclophosphamide cystitis was treated with intravesical silver nitrate instillation to control bleeding. This resulted in apparent reflux and extravasation of the silver nitrate solution with secondary retroperitoneal inflammation. Subsequently, the patient required treatment for a small, fibrotic bladder with persistent reflux. The precautions and recommendations for treatment of such difficult patients are discussed.     

Treatment of intractable bacterial cystitis with intermittent catheterization and antimicrobial instillation: case report

Intractable bacterial cystitis associated with residual urine formation was treated successfully in 4 women by intermittent self-catheterization with instillation of an aminoglycoside directly into the bladder after other methods had failed.     

Single-dose intravesical amikacin instillation for pyocystis in a patient with autonomic dysreflexia: A case report

ContextPyocystis is an infection of the epithelium of the bladder and a frequent complication of anuria. Patients with spinal cord injury (SCI) at the sixth thoracic vertebra (T6) or higher are at a greater risk for autonomic dysreflexia (AD), which can be induced by infections such as pyocystis. Cases of pyocystis treatment with aminoglycoside instillations have been reported in the literature.FindingsWe describe the case of a 59-year-old male with T1 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A complete paraplegia, status post bilateral nephrectomy with recurrent episodes of AD suspected to be caused by pyocystis related to anuria. A bladder specimen culture grew Escherichia coli susceptible to amikacin with a minimum inhibitory concentration (MIC) of ≤ 8 mg/L. In the setting of anuria and with concern that intravenous antibiotics would not adequately reach the site of infection, we chose to treat the patient with a single-dose intravesical instillation of amikacin 25 mg/100 mL left to dwell for approximately 2 h. A repeat bladder culture showed no colonies. The patient remained stable with no episodes of AD and no signs or symptoms of infection one month following treatment.ConclusionThe purpose of this case report is to add to the current literature on intravesical aminoglycoside instillations for pyocystis to aid clinicians in treating future cases, as well as to highlight pyocystis as a potential cause of AD in SCI patients with anuria.     

Successful treatment of cyclophosphamide-induced haemorrhagic cystitis with intravesical prostaglandin E1 in a child with non-Hodgkin's lymphoma

Abstract A 5-year-old male patient with non-Hodgkin's lymphoma developed haemorrhagic cystitisgrade IV due to cyclophosphamide. Intravesical prostaglandin E(1)was administered safely and successfully. This case demonstrates that intravesical prostaglandin E(1) is a safe, easyand effective treatment method in resistant grade IV haemorrhagic cystitis.     

Efficacy of combination therapy with intravesical instillation of doxorubicin and low-dose radiation for bladder cancer Comparison with instillation of doxorubicin alone

Intravesical instillation of doxorubicin (Adriamycin) combined with low-dose irradiation (1,600–2,000 rad) was compared with instillation of doxorubicin alone in patients with various grades of bladder cancer. Therapeutic effects were evaluated clinically and histopathologically. Clinical evaluation based on cystoscopic findings revealed an effective rate of 22 of 49 patients (45 per cent) in the group treated with doxorubicin alone and 43 of 49 patients (88 per cent) in the group treated with combined therapy. Histopathologic examination showed an effective rate of 3 of 49 patients (6 per cent) when doxorubicin alone was used, whereas this rate was 16 of 49 patients (32 per cent) with combination therapy.     

尿路上皮癌膀胱药物灌注致重度膀胱功能损害的碱化利多卡因灌注治疗

目的:评价碱化利多卡因扩张性灌注治疗尿路上皮癌膀胱灌注后药物相关性重度膀胱损害的疗效与安全性。方法:对6例尿路上皮癌患者因行吡柔比星、丝裂霉素及BCG灌注引起的重度膀胱损害,其中3例为灌注BCG行三联抗结核药物等综合治疗无效而被迫放弃、中止治疗者,采用膀胱镜检后碱化利多卡因扩张性灌注方法进行治疗,并评估治疗前、后下尿路症状及其相关指标。结果:6例患者下尿路症状及评分、膀胱容量流率、膀胱敏感性明显改善,并完全恢复原来的化学药物灌注。平均随访10(3～16)个月,无膀胱损害症状复发,效果满意。结论:应用碱化利多卡因扩张性灌注治疗尿路上皮癌膀胱灌注后药物相关性重度膀胱损害,是有效和安全的,可恢复尿路上皮癌患者行膀胱灌注药物的耐受依从性。     

Association between gefitinib and hemorrhagic cystitis and severely contracted bladder: a case report

Background

Carcinoid is an endocrine cell tumor with low-grade atypia, which is generally a low-grade malignant cancer with a good prognosis. Metastatic renal carcinoid is even rarer than primary carcinoids.

Case presentation

We present our experience of a patient with metastatic renal carcinoid from the gastrointestinal tract.

Conclusions

The carcinoid tumor of the kidney in our patient, who had a history of liver metastasis from rectal carcinoid, was considered metastatic based on the pathological findings.     

Prophylactic intravesical instillation therapy in patients with superficial bladder cancer--results of a randomized prospective study]

A randomized prospective study was conducted for the purpose of investigating the efficacy of intravesical chemoprophylaxis of superficial bladder cancers. Eligible patients were randomized into three groups: 1) adriamycin (ADM) group; intravesical instillation with 50 mg of ADM dissolved in 100 ml physiological saline, 2) mitomycin C (MMC) group; intravesical instillation with 30 mg of MMC dissolved in 100 ml of physiological saline, 3) control group; transurethral resection or transurethral coagulation only. The characteristic features of our protocol consisted of frequent (six times) instillations of the drugs within two weeks after transurethral resection, followed by instillations on two consecutive days at four-week intervals for two years. Furthermore, large quantities (100 ml) of instillation fluid containing relatively low concentrations of the drugs (500 micrograms/ml for ADM or 300 micrograms/ml for MMC) were employed. One hundred and forty-four patients have been submitted to the study; 110 patients were fully evaluable for recurrence and 34 patients were eliminated as non-evaluable patients. The cumulative five-year non-recurrence rates of the patients with multiple tumors were 32% in the MMC group, 25% in the ADM group and 7% in the control group. The cumulative non-recurrence rates of the ADM and MMC groups were significantly higher than that of the control group. It is considered that this instillation therapy with ADM and MMC is useful for preventing the recurrence of superficial bladder cancers.     

Successful treatment of right ventricular thrombus with heparin and sodium warfarin therapy: a case report

A 75-year-old woman came to our emergency clinic complaining of abdominal pain. Acute cholecystitis was diagnosed, and parenteral antibiotic therapy was initiated. Because of palpitation, she had a consultation with the cardiology clinic. Echocardiography showed a 2.7 x 2.2 cm mobile thrombus attached to the apex of the right ventricle. Since no thromboembolic complications were present, we decided to begin administering heparin and oral anticoagulant. After the administration of unfractionated heparin for 48 hours, the patient was shifted to low-molecular weight heparin because it is easier to use and requires no follow-up. The patient received low-molecular weight heparin in addition to sodium warfarin for 5 days. Administration of heparin was then stopped and treatment was continued with sodium warfarin. In the series of weekly echocardiography evaluations, a gradual reduction was noted in the apical mass, which was initially considered to be a thrombus, and 3 weeks later evaluation revealed that the thrombus in the right ventricle had disappeared completely. No thromboembolic complications were observed during the follow-up period.     

Local recurrence of micropapillary bladder tumor after radical cystectomy : successful treatment with radiation therapy : a case report

A 75-year-old man consulted a physician because of gross hematuria and right flank pain. Since a bladder tumor and right hydronephrosis were found, the patient was referred to our hospital. The clinical diagnosis was cT3bN0M0 and radical cystectomy was done. The pathological diagnosis was micropapillary variant of urothelial carcinoma, pT3bN0M0. The local recurrence appeared in the interior of the pelvis by computed tomography after the operation. A complete response was obtained by radiotherapy.     

Sequential hydrodistension and intravesical instillation of hyaluronic acid under general anaesthesia for treatment of refractory interstitial cystitis: a pilot study

Pilot study looking at the combination of general anaesthetic hydrodistension and intravesical hyaluronic acid for treatment of refractory interstitial cystitis. Twenty-three treatment refractory patients were recruited with an average age 53.4 years. All underwent general anaesthetic cystoscopy, hydrodistension and instillation of hyaluronic acid (40 mg/50 ml). The bladder was then subsequently drained with the patient awake. Two initial treatments were carried out a month apart and duration between treatments increased depending upon symptom response. In the responders, the average number of treatments was 6.6 (median 4.5), duration between treatments was 3.1 months (median 2.6) and follow-up 15.8 months (median 16). Seventeen patients (74%) responded with immediate improvement in symptoms. In all responders, healing of ulceration and resolution of inflammation occurred. Average anaesthetic bladder capacity increased in the responder group from an average of 492 ml (median 500 ml) to an average of 776 ml (median 700 ml). Our pilot data suggests sequential hydrodistension and hyaluronic acid treatment under general anaesthesia may be considered for resistant cases of interstitial cystitis, especially those that cannot tolerate the instillation procedure under local anaesthesia. Further prospective trials are required.     

Tuberculous epididymitis caused by intravesical BCG therapy: a case report

We describe a case of tuberculous epididymitis that occurred 35 months after completion of a course of intravesical Bacillus Calmette-Guerin (BCG). A 67-year-old man had received trasuretheral resection for bladder cancer in February 1997. Two weeks after the operation, a course of 8 weekly intravesical instillations of BCG (Tokyo 172 strain) was carried out between March and April, 1997. Under the diagnosis of benign prostatic hypertrophy, transuretheral resection of the prostate was performed in March 1998. Multiple tuberculous nodules were histopathologically detected in resected prostatic tissues. The patient complained of a small nodule in the right epididymal tail in August 2001. The nodule developed during 6 weeks, with spontaneous perforation of the scrotal skin and discharge of pus. The pus contained acid-fast bacilli, which were shown to be tubercle bacilli by polymerase chain reaction (PCR) with pan-mycobacterium primer. MPB64-T2, T6 and pncA-7, 11C were positive, while PT-1, 2 and pncA-7, 10 were negative by PCR. These results revealed that Mycobacterium bovis (BCG Organism) was the cause of the epididymitis. Drug therapy for 3 months with rifampicin, isoniazid and ethambutol was initiated in September 2001, and right orchiectomy was performed in October. Histopathological examination showed tuberculous epididymitis. In this case, persistent BCG organisms may have reached the epididymis from the prostate, and may have been activated by immunosuppression associated with aging. In addition, PCR with species-specific primers was useful in differentiating Mycobacterium bovis from Mycobacterium tuberculosis.