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


https://doi.org/10.4081/aiua.2021.2.200
Vol. 93 No. 2 (2021)
Submitted: January 18, 2021
Accepted: March 10, 2021
Published: June 28, 2021
Cystitis, Radiation, Radiotherapy, Hemorrhagic cystitis, Hemorrhagic cystitis therapy, Fibrin glue therapy, Actinic cystitis, HSCT induced cystitis, Allogenic transplant
Abstract Views: 1408
PDF: 669
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Alessandra Cassani
    alessandra.cassani@yahoo.com
    “G. D'Annunzio” University of Chieti, Dept. of Medical, Oral and Biotechnological Sciences, “SS. Annunziata” Hospital, Urology Unit, Chieti, Italy; ASL Abruzzo 2, Department of Urology, Chieti, Italy.
  • Michele Marchioni “G. D'Annunzio” University of Chieti, Dept. of Medical, Oral and Biotechnological Sciences, “SS. Annunziata” Hospital, Urology Unit, Chieti, Italy; ASL Abruzzo 2, Department of Urology, Chieti, Italy.
  • Francesco Silletta “G. D'Annunzio” University of Chieti, Dept. of Medical, Oral and Biotechnological Sciences, “SS. Annunziata” Hospital, Urology Unit, Chieti, Italy; ASL Abruzzo 2, Department of Urology, Chieti, Italy.
  • Carlo D'orta “G. D'Annunzio” University of Chieti, Dept. of Medical, Oral and Biotechnological Sciences, “SS. Annunziata” Hospital, Urology Unit, Chieti, Italy; ASL Abruzzo 2, Department of Urology, Chieti, Italy.
  • Giulia Primiceri “G. D'Annunzio” University of Chieti, Dept. of Medical, Oral and Biotechnological Sciences, “SS. Annunziata” Hospital, Urology Unit, Chieti, Italy; ASL Abruzzo 2, Department of Urology, Chieti, Italy.
  • Ambra Rizzoli “G. D'Annunzio” University of Chieti, Dept. of Medical, Oral and Biotechnological Sciences, “SS. Annunziata” Hospital, Urology Unit, Chieti, Italy; ASL Abruzzo 2, Department of Urology, Chieti, Italy.
  • Patrizia Di Gregorio “SS. Annunziata” Hospital, Chieti, Italy; ASL Abruzzo 2, Servizio di Medicina Trasfusionale ed Ematologia Aziendale Ospedaliero - Centro Emofilia 52, Chieti, Italy.
  • Sandra Verna “SS. Annunziata” Hospital, Chieti, Italy; ASL Abruzzo 2, Servizio di Medicina Trasfusionale ed Ematologia Aziendale Ospedaliero - Centro Emofilia 52, Chieti, Italy.
  • Annalisa Natale Santo Spirito Hospital, Pescara, Department of Hematology, Bone Marrow Transplant Center, Pescara, Italy.
  • Stella Santarone Santo Spirito Hospital, Pescara, Department of Hematology, Bone Marrow Transplant Center, Pescara, Italy.
  • Francesco Berardinelli “G. D'Annunzio” University of Chieti, Dept. of Medical, Oral and Biotechnological Sciences, “SS. Annunziata” Hospital, Urology Unit, Chieti, Italy; ASL Abruzzo 2, Department of Urology, Chieti, Italy.
  • Luigi Schips “G. D'Annunzio” University of Chieti, Dept. of Medical, Oral and Biotechnological Sciences, “SS. Annunziata” Hospital, Urology Unit, Chieti, Italy; ASL Abruzzo 2, Department of Urology, Chieti, Italy.

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.


Hemorrhagic Cystitis - American Urological Association. Available from: https://www.auanet.org/education/auauniversity/education-products-and-resources/pathology-for-urologists/urinary-bladder/cystitis/hemorrhagic-cystitis.

Galla A, Maggio A, Delmastro E, et al. Salvage radiation therapy after radical prostatectomy: survival analysis. Minerva Urol Nefrol. 2019; 71:240. DOI: https://doi.org/10.23736/S0393-2249.18.03124-7

Antonelli A, Palumbo C, Noale M, et al. and the Pros-IT CNR study group. Overview of potential determinants of radical prostatectomy versus radiation therapy in management of clinically localized prostate cancer: results from an Italian, prospective, observational study (the Pros-IT CNR study). Minerva Urol Nefrol. 2020; 72:595-604. DOI: https://doi.org/10.23736/S0393-2249.19.03637-3

Corman JM, McClure D, Pritchett R, et al. Treatment of radiation induced hemorrhagic cystitis with hyperbaric oxygen. J. Urol. 2003; 169:2200–2202. DOI: https://doi.org/10.1097/01.ju.0000063640.41307.c9

Alesawi AM, El-Hakim A, Zorn KC, et al. Radiation-induced hemorrhagic cystitis: Curr. Opin. Support. Palliat. Care. 2014; 8:235-240. DOI: https://doi.org/10.1097/SPC.0000000000000073

Pascoe C, Duncan C, Lamb BW, et al. Current management of radiation cystitis: a review and practical guide to clinical management. BJU Int. 2019; 123:585-594. DOI: https://doi.org/10.1111/bju.14516

Browne C, Davis NF, Mac Craith E, et al. A Narrative review on the pathophysiology and management for radiation cystitis. Adv Urol. 2015; 2015:1-7. DOI: https://doi.org/10.1155/2015/346812

Dautruche A, Delouya G. A contemporary review about the management of radiation-induced hemorrhagic cystitis: Curr Opin Support Palliat Care 2018; 12:344-350. DOI: https://doi.org/10.1097/SPC.0000000000000375

Mangano MS, De Gobbi A, Ciaccia M, et al. Actinic cystitis: causes, treatment and experience of a single centre in the last five years. Urol J. 2018; 85:25-28. DOI: https://doi.org/10.5301/uj.5000273

Calderone CE, Lerner SP, Taylor JM. The case for salvage cystectomy after pelvic radiation. Minerva Urol Nefrol. 2016; 68:161-71.

Update Series (2015) Lesson 3: Management of emergency bleeding, recalcitrant clots and hemorrhagic cystitis | AUA University. Available from: https://auau.auanet.org/node/4709.

Tirindelli MC, Flammia GP, Bove P, et al. Fibrin glue therapy for severe hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation. Biol. Blood Marrow Transplant. 2014; 20:1612-1617. DOI: https://doi.org/10.1016/j.bbmt.2014.06.018

Bove P, Iacovelli V, Tirindelli MC, et al. Endoscopic intravesical fibrin glue application in the treatment of refractory hemorrhagic radiation cystitis: a single cohort pilot study. J Endourol. 2019; 33:93-98. DOI: https://doi.org/10.1089/end.2018.0028

Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31:1341-1346. DOI: https://doi.org/10.1016/0360-3016(95)00060-C

Dodd RA, Cornwell R, Holm NE, et al. The Vivostat application system: a comparison with conventional fibrin sealant application systems. Technol Health Care. 2002; 10:401-11. DOI: https://doi.org/10.3233/THC-2002-10504

O’Leary MP, Sant GR, Fowler FJ, et al. The interstitial cystitis symptom index and problem index. Urology. 1997; 49:58-63. DOI: https://doi.org/10.1016/S0090-4295(99)80333-1

Engeler D, Baranowski AP, Berghmans B, et al. EAU Guidelines on Chronic Pelvic Pain 2020. In: European Association of Urology Guidelines. 2020 Edition. European Association of Urology Guidelines Office, 2020, Arnhem, The Netherlands.

Schips L, Dalpiaz O, Cestari A, et al. Autologous fibrin glue using the Vivostat system for hemostasis in laparoscopic partial nephrectomy. Eur Urol. 2006; 50:801-805. DOI: https://doi.org/10.1016/j.eururo.2006.03.010

Gidaro S, Cindolo L, Lipsky K, et al. Efficacy and safety of the haemostasis achieved by Vivostat system during laparoscopic partial nephrectomy. Arch Ital. Urol Androl. 2009; 81:223-227.

Farouk A, Tawfick A, Reda M, et al. Fibrin glue as a sealant in stentless laparoscopic pyeloplasty: A randomised controlled trial. Arab J Urol. 2019; 17:228-233. DOI: https://doi.org/10.1080/2090598X.2019.1611990

Garayev A, Aytaç Ö, Tavukcu HH, et al. Effect of Autologous Fibrin Glue on Lymphatic Drainage and Lymphocele Formation in Extended Bilateral Pelvic Lymphadenectomy in Robot-Assisted Radical Prostatectomy. J. Endourol. 2019; 33:761-766. DOI: https://doi.org/10.1089/end.2018.0853

Seber A, Shu X, Defor T, et al. Risk factors for severe hemorrhagic cystitis following BMT. Bone Marrow Transplant. 1999; 23:35-40. DOI: https://doi.org/10.1038/sj.bmt.1701523

Leung A, Mak R, Lie A, et al. Clinicopathological features and risk factors of clinically overt haemorrhagic cystitis complicating bone marrow transplantation. Bone Marrow Transplant. 2002; 29:509-513. DOI: https://doi.org/10.1038/sj.bmt.1703415

Imperatore V, Creta M, Di Meo S, et al. Intravesical administration of combined hyaluronic acid and chondroitin sulfate can improve symptoms in patients with refractory bacillus Calmette-Guerin induced chemical cystitis: Preliminary experience with oneyear follow-up. Arch Ital Urol Androl. 2018; 90:11-14. DOI: https://doi.org/10.4081/aiua.2018.1.11

Masieri L, Sessa F, Mari A, et al. Intravesical application of platelet-rich plasma in patients with persistent haemorrhagic cystitis after hematopoietic stem cell transplantation: a single-centre preliminary experience. Int Urol Nephrol. 2019; 51:1715-1720. DOI: https://doi.org/10.1007/s11255-019-02223-0

Sosnowski R, Kulpa M, Kosowicz M, et al. Basic methods for the assessment of health-related quality of life in uro-oncological patients. Minerva Urol Nefrol. 2017; 69:409-420.

Cassani, A., Marchioni, M., Silletta, F., D’orta, C., Primiceri, G., Rizzoli, A., Di Gregorio, P., Verna, S., Natale, A. ., Santarone, S., Berardinelli, F., & Schips, L. (2021). 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. Archivio Italiano Di Urologia E Andrologia, 93(2), 200–205. https://doi.org/10.4081/aiua.2021.2.200

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC