Superselective embolization of vesical arteries for management of hemorrhagic cystitis caused by BK polyomavirus

Year 2018, Volume: 13 Issue: 3, 52 - 55, 01.10.2018

Sadık Server Ömer Aytaç Safiye Koçulu , Tülay Özçelik Hasan Hüseyin Tavukçu Hasan Sami Göksay Fatih Altuğ Mutlu Arat

Abstract

A 36 year- old male patient who had
received an allogeneic stem cell transplanta-
tion from a non- familial identical donor for
the treatment of non- Hodgkin lymphoma
19 days ago admitted to the emergency de-
partment with macroscopic hematuria. A
BK virus induced hematuria was diagnosed
and conservative measures failed to get his
heamaturia under control.Hyperbaric oxygen
therapy and Cidofovir treatment had also
failed. Then bilateral percutaneous neph-
rostomies were inserted followed by selec-
tive angioembolization of vesical arteries
one week later. Two weeks after angioembo-
lization both nephrostomies were clamped
sequentially and the patient was able to pass
urine comfortably without any haematuria.
Management of heamorrhagic cystitis by a
stepwise, rapid multi-disciplinary approach
can be a critical factor in the success of stem
cell transplantation. 

Keywords

ngioembolization , cystitis , hematuria , lymphoma , stem cell transplanta- tion

BK Virüse bağlı hemorajik sistitte süperselektif mesane arter embolizasyonu

Abstract

Otuz altı yaşında erkek hasta, non Hodg­kin lenfoma
tanısıyla allojenik kök hücre nak­li sonrası 19. günde makroskopik hematüri ile
başvurdu. Hematürinin BK virüse bağlı geliştiği saptandı. Konservatif yaklaşım
ile hematüri kontrol altına alınamadı. Hiperba­rik oksijen tedavisi ve
Sidofovir intravezikal tedavisi denendi ancak başarılı olmadı. Ta­kiben hastaya
bilateral perkütan nefrostomi takılıp 1 hafta sonra kanayan mesane arterleri
selektif olarak embolize edildi. İşlemden 2 hafta sonra nefrostomi klempe
edildi, hasta­nın rahatlıkla idrar yaptığı ve hematürisinin olmadığı görüldü.
Basamaklı hızlı multidi­sipliner yaklaşım ile hemorajik sistit yönetimi kök
hücre nakli başarısı açısından da önem arz etmektedir.

Keywords

anjiyoembolizasyon , hematüri , kök hücre nakli , lenfoma , sistit

References

• 1. Gaziev J, Paba P, Miano R, Germani S, Sodani P, Bove P, Perno CF, Marziali M, Gallucci C, Isgro A, Paciaroni K, Roveda A, Simone MD, De Angelis G, Alfieri C, Lucarelli G. Late-onset hemorrhagic cystitis in children after hemato- poietic stem cell transplantation for thalassemia and sickle cell anemia: a prospective evaluation of polyoma (BK) virus infection and treatment with cidofovir. Biol Blood Marrow Transplant 2010 ;16:662-71.
• 2. Fanourgiakis P, Georgala A, Vekemans M, Triffet A, De Bruyn JM, Duchateau V, Martiat P, De Clercq E, Snoeck R, Wollants E, Rector A, Van Ranst M, Aoun M. Intravesical instillation of cidofovir in the treatment of hemorrhagic cystitis caused by adenovirus type 11 in a bone marrow transplant recipient. Clin Infect Dis 2005; 40:199-201.
• 3. Sakurada M, Kondo T, Umeda M, Kawabata H, Yamashita K, Takaori-Kondo A. Successful treatment with intravesi- cal cidofovir for virus-associated hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: A case report and a review of the literature. J Infect Chemother 2016;22:495-500.
• 4. De Berardinis E, Vicini P, Salvatori F, Sciarra A, Gentile V, Di Silverio F. Superselective embolization of bladder arter- ies in the treatment of intractable bladder haemorrhage. In- ternational journal of urology 2005;12:503-5.
• 5. Gine E, Rovira M, Real I, Burrel M, Montana J, Carreras E, Montserrat E. Successful treatment of severe hemorrhagic cystitis after hemopoietic cell transplantation by selective embolization of the vesical arteries. Bone Marrow Trans- plant 2003 ;31:923-5.