Efficacy and safety of intravesical fibrin glue instillation for management of patients with refractory hemorrhagic cystitis: 12-months results. A promising therapy for hemorrhagic cystitis
| Autor: | Luigi Schips, Patrizia Di Gregorio, Michele Marchioni, Annalisa Natale, Ambra Rizzoli, Carlo D'Orta, Francesco Berardinelli, Stella Santarone, Sandra Verna, Giulia Primiceri, Francesco Silletta, Alessandra Cassani |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Hemorrhage Fibrin Tissue Adhesive Hematopoietic stem cell transplantation Bladder Irrigation 03 medical and health sciences 0302 clinical medicine Refractory Cystitis Hemorrhagic cystitis medicine Humans Fibrin glue Adverse effect Radiation Radiotherapy medicine.diagnostic_test business.industry Hematopoietic Stem Cell Transplantation Hemorrhagic cystitis therapy Interstitial cystitis Cystoscopy medicine.disease Diseases of the genitourinary system. Urology Administration Intravesical Fibrin glue therapy 030220 oncology & carcinogenesis RC870-923 business |
| Zdroj: | Archivio Italiano di Urologia e Andrologia, Vol 93, Iss 2 (2021) |
| ISSN: | 2282-4197 1124-3562 |
| Popis: | Objectives: Fibrin glue (FG) endo-vesical application seems to be a promising therapy for hemorrhagic cystitis (HC). We aimed to evaluate efficacy and safety of FG instillation in patients with HC. Methods: Patients with HC not responsive to conventional treatments (bladder irrigation, catheterization, blood transfusions, hyperhydration and endoscopic coagulation) were treated with FG endo-vesical instillation (April 2017- December 2018). FG was prepared from 120 mL of patient blood with the Vivostat® system. After standard cystoscopy, bladder was insufflated with carbon dioxide (CO2) according to bladder compliance and autologous FG was applied to bladder wall and bleeding sites. Results: Ten patients included with grade 2 or higher HC secondary to bone marrow graft for hematological diseases (30%) or to actinic cystitis caused by prostate cancer radiotherapy (RT) (70%). The median HC onset time after RT was 4.8 (IQR 3.9- 6.3) years and 35 (IQR 27.5-62.5) days after hematopoietic stem cell transplantation (HSCT). Five patients had a complete response after one treatment, three patients had clinical response (grade < 2 hematuria, amelioration of symptoms), one of them required catheterization and bladder irrigation. One patient required a second instillation of FG achieving a clinical response. No adverse events related to the procedure were recorded, however one patient died for causes not related to the procedure. Median Interstitial Cystitis Symptoms Index was 13.0 (IQR 11.0-15.0) pre-operatively and 4.0 (IQR 2.0-5.0) post-operatively. Conclusions: Our study showed that, even in hematological patients, autologous FG instillation maybe a safe, repeatable and effective treatment modality in patients with refractory HC. |
| Databáze: | OpenAIRE |
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