International Journal of Cancer Therapy and Oncology www.ijcto.org Copyright © Vasdev et al. ISSN 2330-4049 Nikhil Vasdev 1,3* , Angela Davidson 1 , Christian Harkensee 2 , Mary Slatter 2 , Andrew R Gennery 2 , Ian E Willetts 3 , Andrew C Thorpe 1 1 Departmentof Urology, Freeman Hospital, Newcastle upon Tyne, UK 2 Supra-regional Children’s Bone Marrow Transplant Unit (CBMTU), Newcastle General Hospital, Newcastle upon Tyne, UK 3 Department of Paediatric Urology, Royal Victoria Infirmary, Newcastle upon Tyne, UK Received August 19, 2013; Revised September 06, 2013; Accepted September 07, 2013; Published Online September 09, 2013 Original Article Abstract Aim: Haemorrhagic cystitis (HC) is uncommon and in its severe form potentially life threatening complication of Haematopoi- etic stem cell transplantation (HSCT) in children. We present our single centre experience in the urological management of this clinically challenging condition. Patients and Methods: Fourteen patients were diagnosed with BK-Virus HC in our centre. The mean age at diagnosis was 8.8 years (range, 3.2-18.4 years). The mean number of days post-BMT until onset of HC was 20.8 (range, 1 – 51). While all patients tested urine positive for BKV at the clinical onset of HC, only four patients had viral quantifi- cation, with viral loads ranging from 97,000 to >1 billion/ml. 8 patients had clinical HC. Ten patients experienced acute GVHD (grade I: 6 patients, grade II: 3 patients, grade 4: 1 patient). Results: Four patients received medical management for their HC. Treatments included hyperhydration, MESNA, blood and platelet transfusion, premarin and oxybutynin (Table 6). Two pa- tients received both medical and surgical management which included cystoscopy with clot evacuation, bladder irrigation and supra-pubic catheter insertion. One patient received exclusive surgical management. Seven patients were treated conservative- ly. Conclusion: There is limited available evidence for other potential therapeutic strategies highlighting the need for more re- search into the pathophysiology of HSCT-associated HC. Commonly used interventions with possible clinical benefit (e.g. cidofovir, ciprofloxacin) still require to be evaluated in multi-centre, high-quality studies. Potential future preventative and therapeutic options, such as modulation of conditioning, immunosuppression and engraftment, new antiviral and an- ti-inflammatory and less nephrotoxic agents need to be assessed. Keywords: Haemorrhagic Cystitis; Haemopoitic Stem Cell Transplant; Urological Management; Patient Outcome Introduction A significant number of children undergo haematopoietic stem cell transplantation (HSCT) for a range of indications each year. There are various side effects and complications well understood, many of which occur secondary to immu- nosuppression. Haemorrhagic cystitis (HC) is characterised by haemorrhagic inflammation of bladder mucosa which results in painful micturition associated with haematuria. The clinical course of HC following HSCT can vary from from mild and brief (Grade I) to severe, prolonged and life-threatening (Grade IV). 1, 2 Patients who develop HC following HSCT the onset have either an early or late onset presentation. Early onset occurs within days of transplantation and is associated with associ- ated with conditioning regimen (chemotherapy or irradia- tion). The late-onset form occurs post-engraftment and is associated with the reactivation of urotropic viruses, princi- pally BK virus, Adenovirus and CMV. 3 In current literature, numerous conditioning regimens have been used which in- *Corresponding author: Mr. Nikhil Vasdev, FRCS (Urology), Senior Specialist Registrar, Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Phone: +44 (0) 1912336161; Fax: +44 (0) 1912137127. Email: nikhilvasdev@doctors.org.uk Cite this article as: Vasdev N, Davidson A, Harkensee C, Slatter M, Gennery A, Willetts I, Thorpe A. Urological management (medical and surgical) of BK-virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation. Int J Cancer Ther Oncol 2013; 1(1):01013. DOI: 10.14319/ijcto.0101.3 Urological management (medical and surgical) of BK-virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation