Ultrasonografia w diagnostyce krwotocznego zapalenia pęcherza moczowego po przeszczepach szpiku kostnego u dzieci

• Authors: Urszula Zaleska-Dorobisz , Anna Biel , Dąbrówka Sokołowska-Dąbek , Cyprian Olchowy , Mateusz Łasecki

Title variants

EN

Ultrasonography in the diagnosis of hemorrhagic cystitis – a complication of bone marrow transplantation in pediatric oncology patients

• Languages of publication: EN PL

Abstracts

EN

Objective: The aim of this study was to evaluate the usefulness of ultrasonography in the diagnosis of hemorrhagic cystitis following bone marrow transplantation in children. Material and methods: The study involved an analysis of clinical material and the results of imaging tests performed in 334 patients who underwent hematopoietic cell transplantation. Ultrasonographic findings in 42 patients with hemorrhagic cystitis were analyzed in detail. The ultrasound images served to assess the severity of hemorrhagic cystitis and the results were compared with the clinical assessment of the disease on the Droller scale, as well as the laboratory and endoscopic tests. Results: In the studied group of patients hemorrhagic cystitis following allogeneic transplantation was diagnosed in 12.5% cases. 73.8% patients received transplants from unrelated donors, 26.2% – from compatible siblings. The study revealed a higher incidence of hemorrhagic cystitis in children above 10 years of age. Grade 3 according to the Droller was diagnosed in 42.9%, grade 2 – in 30.9%, grade 4 – in 14.3%, and grade 1 – in 11.9% patients. The number of ultrasound examinations depended on the clinical symptoms, severity, duration and co-occurrence of other complications following the transplantation and was within the 1–15 range (average: 4.6). Grades 3 and 4 were related to the poor clinical condition of the patients and to their longer hospitalization. During this period there was an increased risk of renal malfunction and acute renal failure, post-inflammatory narrowing of the ureters, hydronephrosis, and in grade 4 the fibrosis of the bladder with reduced bladder capacity. Analyses demonstrated a significant correlation between the ultrasound image of the bladder wall and the clinical severity. Conclusions: Ultrasound with Doppler options remains the primary diagnostic tool in the evaluation of hemorrhagic cystitis, and is useful in terms of its diagnosis, determination of the severity, and monitoring of the treatment.

PL

Cel: Celem pracy była ocena przydatności ultrasonografii w diagnostyce krwotocznego zapalenia pęcherza moczowego, dość częstego powikłania po przeszczepach szpiku kostnego u dzieci. Materiał i metoda: W pracy przeanalizowano materiał kliniczny i wyniki badań obrazowych 334 pacjentów po transplantacji komórek hematopoetycznych. Analizie poddano wyniki badań ultrasonograficznych wykonanych u 42 dzieci z krwotocznym zapaleniem pęcherza moczowego. Na podstawie USG oceniano stopień zaawansowania krwotocznego zapalenia pęcherza moczowego, a wyniki porównywano z oceną kliniczną procesu w skali Drollera, badaniami laboratoryjnymi i endoskopowymi. Wyniki: W analizowanej grupie dzieci krwotoczne zapalenie pęcherza moczowego rozpoznano po transplantacjach allogenicznych u 12,5% badanych, u 73,8% był to przeszczep od dawcy niespokrewnionego, u 26,2% – od zgodnego rodzeństwa. Wykazano częstsze występowanie krwotocznego zapalenia pęcherza moczowego u dzieci starszych, powyżej 10. roku życia. Stopień 3. w skali Drollera stwierdzono u 42,9% dzieci, stopień 2. – u 30,9%, stopień 4. – u 14,3%, a stopień 1. – u 11,9% dzieci. Liczba badań ultrasonograficznych i rozpoznanie zależały od objawów klinicznych, stopnia zaawansowania, czasu trwania oraz współwystępowania innych powikłań po transplantacji i wynosiła 1–15 (średnio 4,6). Trzeci i czwarty stopień wiązały się ze złym stanem klinicznym chorych, a także wydłużeniem czasu hospitalizacji. W okresie tym wzrastało ryzyko uszkodzenia czynności nerek i ostrej niewydolności nerek, pozapalnego zwężenia moczowodów, wodonercza, a w końcowym stadium zwłóknienia pęcherza moczowego. Stwierdzono istotną zależność obrazu ultrasonograficznego zmienionej w przebiegu zapalenia ściany pęcherza moczowego, ze stopniem klinicznego zaawansowania. Wnioski: Badanie ultrasonograficzne z opcjami dopplerowskimi pozostaje podstawowym badaniem diagnostycznym w ocenie krwotocznego zapalenia pęcherza moczowego, jest przydatne w rozpoznawaniu, określaniu stopnia zaawansowania choroby i monitorowaniu leczenia.

Keywords

EN

bone marrow transplantation; diagnostics; diagnostyka; hemorrhagic cystitis; krwotoczne zapalenie pęcherza moczowego; przeszczep szpiku kostnego; ultrasonografia; ultrasound

Discipline

• MEDICINE: MEDICINE

• Journal: Journal of Ultrasonography
• Year: 2014
• Volume: 14
• Issue: 58
• Pages: 258-272

Contributors

author

Urszula Zaleska-Dorobisz

• Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Curie-Skłodowskiej 68, 50-369 Wrocław, Poland, tel.: [phone],

author

Anna Biel

• Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Wrocław, Poland

author

Dąbrówka Sokołowska-Dąbek

• Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Wrocław, Poland

author

Cyprian Olchowy

• Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Wrocław, Poland

author

Mateusz Łasecki

• Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Wrocław, Poland

References

• 1. Kowalczyk JR, Dudkiewicz E, Balwierz W, Bogusławska-Jaworska J, Rokicka-Milewska R: Incidence of childhood cancers in Poland in 1995–1999. Med Sci Monit 2002; 8: CR587–CR590.
• 2. Kramárová E, Stiller CA: The international classification of childhood cancer. Int J Cancer 1996; 68: 759–765.
• 3. Pizzo PA, Poplack DG (eds.): Principles and Practice of Pediatric Oncology. Lippincott Williams & Wilkins, Philadelphia 2011.
• 4. Chybicka A, Sawicz-Birkowska K (eds.): Onkologia i hematologia dziecięca. Wydawnictwo Lekarskie PZWL, Warszawa 2008.
• 5. Ljungman P, Urbano-Ispizua A, Cavazzana-Calvo M, Demirer T, Dini G, Einsele H et al.; European Group for Blood and Marrow: Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: definitions and current practice in Europe. Bone Marrow Transplant 2006; 37: 439–449.
• 6. Myers KC, Davies SM: Hematopoietic stem cell transplantation for bone marrow failure syndromes in children. Biol Blood Marrow Transplant 2009; 15: 279–292.
• 7. Espigado I, Marin-Niebla A, Perez-Hurtado JM, Rios E, Carmona M, Plaza E et al.: Hemopoietic stem cell transplantation in childhood: reduction in mortality and improvement of survival over the years. Transplant Proc 2005; 37: 1555–1556.
• 8. Wójcik B, Kowalczyk JR, Chybicka A, Wachowiak J, Drabko K, Zaucha-Prazmo A et al.: [Autologous stem-cell transplantations in children with non-Hodgkin lymphomas]. Przegl Lek 2004; 61 Suppl 2: 53–56.
• 9. Gorczyńska E: Krwotoczne zapalenie pęcherza jako problem epidemiologiczny i kliniczny u dzieci po przeszczepieniu komórek hematopoetycznych. Rozprawa habilitacyjna. Wrocław 2006.
• 10. Droller MJ, Saral R, Santos G: Prevention of cyclophosphamide-induced hemorrhagic cystitis. Urology 1982; 20: 256–258.
• 11. Gorczynska E, Turkiewicz D, Rybka K, Toporski J, Kalwak K, Dyla A et al.: Incidence, clinical outcome, and management of virus-induced hemorrhagic cystitis in children and adolescents after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2005; 11: 797–804.
• 12. Azzi A, Fanci R, Bosi A, Ciappi S, Zakrzewska K, de Santis R et al.: Monitoring of polyomavirus BK viruria in bone marrow transplantation patients by DNA hybridization assay and by polymerase chain reaction: an approach to assess the relationship between BK viruria and hemorrhagic cystitis. Bone Marrow Transplant 1994; 14: 235–240.
• 13. Erer B, Angelucci E, Baronciani D, Tomasucci M, Giardini C, Gaziev J: Hemorrhagic cystitis after allogeneic bone marrow transplantation for thalassemia. Bone Marrow Transplant 1993; 12 Suppl 1: 93–95.
• 14. Russell SJ, Vowels MR, Vale T: Haemorrhagic cystitis in paediatric bone marrow transplant patients: an association with infective agents, GVHD and prior cyclophosphamide. Bone Marrow Transplant 1994; 13: 533–539.
• 15. Erard V, Kim HW, Corey L, Limaye A, Huang ML, Myerson D et al.: BK DNA viral load in plasma: evidence for an association with hemorrhagic cystitis in allogeneic hematopoietic cell transplant recipients. Blood 2005; 106: 1130–1132.
• 16. McCarville MB, Hoffer FA, Gingrich JR, Jenkins JJ 3rd: Imaging findings of hemorrhagic cystitis in pediatric oncology patients. Pediatr Radiol 2000; 30: 131–138.
• 17. Decker DB, Karam JA, Wilcox DT: Pediatric hemorrhagic cystitis. J Pediatr Urol 2009; 5: 254–264.
• 18. Kirsten D, Hartert A, Willenbacher N, Basara N, Blau A, Fauser A et al.: Incidence and outcome of BK-Virus-induced hemorrhagic cystitis in patients receiving allogeneic BMT/PBSCT. Bone Marrow Transplant 1999; 23 Suppl 1: S117.
• 19. Kondo M, Kojima S, Kato K, Matsuyama T: Late-onset hemorrhagic cystitis after hematopoietic stem cell transplantation in children. Bone Marrow Transplant 1998; 22: 995–998.
• 20. Lee GW, Lee JH, Choi SJ, Kim S, Seol M, Kim WK et al.: Hemorrhagic cystitis following allogeneic hematopoietic cell transplantation. J Korean Med Sci 2003; 18: 191–195.
• 21. Seber A, Shu XO, Defor T, Sencer S, Ramsay N: Risk factors for severe hemorrhagic cystitis following BMT. Bone Marrow Transplant 1999; 23: 35–40.
• 22. Cartoni C, Arcese W, Avvisati G, Corinto L, Capua A, Meloni G: Role of ultrasonography in the diagnosis and follow-up of hemorrhagic cystitis after bone marrow transplantation. Bone Marrow Transplant 1993; 12: 463–467.
• 23. Shah AJ, Lenarsky C, Kapoor N, Crooks GM, Kohn DB, Parkman R et al.: Busulfan and cyclophosphamide as a conditioning regimen for pediatric acute lymphoblastic leukemia patients undergoing bone arrow transplantation. J Pediatr Hematol Oncol 2004; 26: 91–97.
• 24. Jequier S., Rousseau O.: Sonographic measurements of the normal bladder wall in children. AJR Am J Roentgenol 1987; 149: 563–566.
• 25. Hassan Z, Remberger M, Svenberg P, Elbander M, Omazic B, Mattsson J et al.: Hemorrhagic cystitis: a retrospective single-center survey. Clin Transplant 2007; 21: 659–667.
• 26. Brock N, Stekar J, Pohl J, Niemeyer U, Scheffler G: Acrolein, the causative factor of urotoxic side-effects of cyclophosphamide, ifosfamide, trofosfamide and sufosfamide. Arzneimittelforschung 1979; 29: 659–661.
• 27. Hale GA, Rochester RJ, Heslop HE, Krance RA, Gingrich JR, Benaim E et al.: Hemorrhagic cystitis after allogeneic bone marrow transplantation in children: clinical characteristics and outcome. Biol Blood Marrow Transplant 2003; 9: 698–705.
• 28. Hale GA, Heslop HE, Krance RA, Brenner MA, Jayawardene D, Srivastava DK et al.: Adenovirus infection after pediatric bone marrow transplantation. Bone Marrow Transplant 1999; 23: 277–282.
• 29. Giraud G, Bogdanovic G, Priftakis P, Remberger M, Svahn BM, Barkholt L et al.: The incidence of hemorrhagic cystitis and BK-viruria in allogeneic hematopoietic stem cell recipients according to intensity of the conditioning regimen. Haematologica 2006; 91: 401–404.
• 30. Azzi A, Cesaro S, Laszlo D, Zakrzewska K, Ciappi S, De Santis R et al.: Human polyomavirus BK (BKV) load and haemorrhagic cystitis in bone marrow transplantation patients. J Clin Virol 1999; 14: 79–86.
• 31. Akiyama H, Kurosu T, Sakashita C, Inoue T, Mori Si, Ohashi K et al.:Adenovirus is a key pathogen in hemorrhagic cystitis associated with bone marrow transplantation. Clin Infect Dis 2001; 32: 1325–1330.
• 32. Comar M, D’Agaro P, Andolina M, Maximova N, Martini F, Tognon M et al.: Hemorrhagic cystitis in children undergoing bone marrow transplantation: a putative role for simian virus 40. Transplantation 2004; 78: 544–548.
• 33. Binet I, Nickeleit V, Hirsch HH: Polyomavirus infections in transplant recipients. Curr Opin Organ Transplant 2000; 5: 210–216.
• 34. Rabenau HF, Preiser W, Franck S, Schwerdtfeger S, Doerr HW: Polyomavirus viruria in bone marrow transplant recipients: lack of correlation with clinical symptoms. Infection 2002; 30: 91–93.
• 35. Biel SS, Nitsche A, Kurth A, Siegert W, Ozel M, Gelderblom HR: Detection of human polyomaviruses in urine from bone marrow transplant patients: comparison of electron microscopy with PCR. Clin Chem 2004; 50: 306–312.

• Document Type: article