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inflammation of the urinary bladder and ureters
of or relating to a hemorrhage (同)haemorrhagic

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膀胱(ぼうこう)炎

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/22 08:54:41」(JST)

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Hemorrhagic cystitis or Haemorrhagic cystitis is defined by lower urinary tract symptoms that include dysuria, hematuria, and hemorrhage. The disease can occur as a complication of cyclophosphamide, ifosfamide and radiation therapy. In addition to hemorrhagic cystitis, temporary hematuria can also be seen in bladder infection or in children as a result of viral infection.

Causes

Causes of hemorrhagic cystitis include chemotherapy (e.g. cyclophosphamide, Ifosfamide), radiation, or infection. Ifosfamide is the most common cause of hemorrhagic cystitis. Radiation-induced hemorrhagic cystitis develops in similar or smaller patient numbers when compared to cyclophosphamide-induced cases.^[1]

Adenovirus (particularly serotypes 11 and 21 of subgroup B) is the most common cause of acute viral hemorrhagic cystitis in children, though it can result from BK virus as well. A chemical hemorrhagic cystitis can develop when vaginal products are inadvertently placed in the urethra. Gentian violet douching to treat candidiasis has resulted in hemorrhagic cystitis when the drug was misplaced in the urethra, but this hemorrhagic cystitis resolved spontaneously with cessation of treatment. Accidental urethral placement of contraceptive suppositories has also caused hemorrhagic cystitis in several patients. The bladder irritation was thought to be caused by the spermicidal detergent nonoxynol-9. In the acute setting, the bladder can be copiously irrigated with alkalinized normal saline to minimize bladder irritation.

Although hemorrhagic cystitis post-transplantation/bone marrow transplantation is not technically infectious, a short discussion^{[clarification needed]} is in order for completeness. Patients undergoing therapy to suppress the immune system are at risk for hemorrhagic cystitis due to either the direct effects of chemotherapy or activation of dormant viruses in the kidney, ureter, or bladder.^[2] Hemorrhagic cystitis are blood cyst usually found on ovaries.^{[clarification needed]}

Diagnosis

Diagnosis is made by history and examination.

In immunocompromised patients, pus is present in the urine but often no organism can be cultured. In children, polymerase chain reaction sequencing of urine can detect fragments of the infectious agent.

The procedure differs somewhat for women and men. Laboratory testing of urine samples now can be performed with dipsticks that indicate immune system responses to infection, as well as with microscopic analysis of samples. Normal human urine is sterile. The presence of bacteria or pus in the urine usually indicates infection. The presence of hematuria, or blood in the urine, may indicate acute UTIs, kidney disease, kidney stones, inflammation of the prostate (in men), endometriosis (in women), or cancer of the urinary tract. In some cases, blood in the urine results from athletic training, particularly in runners.

Treatment

Unfortunately mesna is ineffective as a treatment once hemorrhagic cystitis has developed. Although rare, once a case of radiation-induced hemorrhagic cystitis is diagnosed there is no empirically-proven treatments to heal this type of condition, which can severely degrade a patient's quality of life and might possibly lead to renal failure with risk of death.

Viral hemorrhagic cystitis in children generally spontaneously resolves within a few days.

The first step in the treatment of HC should be directed toward clot evacuation. Bladder outlet obstruction from clots can lead to urosepsis, bladder rupture, and renal failure. Clot evacuation can be performed by placing a wide-lumen bladder catheter at bedside. The bladder can be irrigated with water or sodium chloride solution. The use of water is preferable because water can help with clot lysis. Care must be taken to not overdistend the bladder and cause a perforation.^[3]

References

^ Marcos Perez-Brayfield. "Hemorrhagic Cystitis: eMedicine".
^ Joseph Basler. "Hemorrhagic Cystitis: Noninfectious". Retrieved 2008-11-24.
^ Marcos Perez-Brayfield. "Hemorrhagic Cystitis". Retrieved 2008-11-24.

UpToDate Contents

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1. 癌患者における膀胱炎 cystitis in patients with cancer
2. 急性膀胱炎：2歳以上の小児および思春期における臨床的特徴および診断 acute cystitis clinical features and diagnosis in children older than two years and adolescents
3. 造血細胞移植後の感染症の概要 overview of infections following hematopoietic cell transplantation
4. JC、BKおよびその他のポリオーマウイルス感染の臨床症状、および診断 clinical manifestations and diagnosis of jc bk and other polyomavirus infections
5. 炎症性疾患におけるシクロホスファミドの全身毒性 general toxicity of cyclophosphamide in inflammatory diseases

English Journal

A phase I study of palifosfamide in combination with doxorubicin: Safety and preliminary efficacy.

Camacho LH1, Chawla SP1, Chua V1, Abbadessa G1, Komarnitsky PB1, Lewis J1.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology.J Clin Oncol.2009 May 20;27(15_suppl):10577.
10577 Background: Palifosfamide, a bi-functional DNA alkylator is the active metabolite of ifosfamide (IFOS), that lacks the toxicity associated with non-active IFOS metabolites and does not require activation. Recent phase II data shows single agent activity in advanced refractory sarcoma. Marked p
PMID 27963756

A phase I study of the safety and pharmacokinetics (PK) of XMT-1001 given as an intravenous (IV) infusion once every three weeks to patients with advanced solid tumors.

Sausville E1, Garbo L1, Weiss GJ1, Anthony S1, Shkolny D1, Yurkovetskiy AV1, Bethune C1, Fram RJ1.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology.J Clin Oncol.2009 May 20;27(15_suppl):2574.
2574 Background: XMT-1001 is a water soluble macromolecular conjugate of camptothecin (CPT). In this novel CPT pro- drug, CPT is conjugated with a 70 kDa biodegradable hydrophilic polyacetal, poly (1-hydroxymethylethylene hydroxymethylformal). XMT-1001 demonstrated an improved therapeutic window as
PMID 27961894

[Significance of Urological Surgical Treatment for Viral Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation].

Kurosawa K1, Urakami S1, Ishiwata K2, Miyagawa J1, Sakaguchi K1, Fujioka M1, Murata H1, Inoshita N3, Taniguchi S2, Okaneya T1.
Hinyokika kiyo. Acta urologica Japonica.Hinyokika Kiyo.2016 Nov;62(11):563-567. doi: 10.14989/ActaUrolJap_62_11_563.
This study investigated the significance of urological surgical intervention for viral hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 1, 024 patients underwent allo-HSCT at our medical center between January 2006 and July 2014. In the 6 pat
PMID 27919133

Japanese Journal

Cytomegalovirus Hemorrhagic Cystitis in a Malignant Glioma Patient Treated with Temozolomide: A Case Report

Intern. Med., 2018
NAID 130006742473

小児における腎尿路の感染症・奇形と超音波検査

超音波医学 44(6), 509-517, 2017
NAID 130006207171

臍帯血移植後に膀胱炎症状を呈さず腎機能障害で発症したBK ウイルス腎症の1 例

日児腎誌 30(2), 164-169, 2017
NAID 130006201490

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