Sadık SERVER, Ömer AYTAÇ, Safiye KOÇULU, Emine Tülay ÖZÇELİK, Hasan Hüseyin TAVUKÇU, Hasan Sami GÖKSAY, Fatih ALTUĞ, Mutlu ARAT

BK Virüse bağlı hemorajik sistitte süperselektif mesane arter embolizasyonu

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.

Anahtar Kelimeler:

anjiyoembolizasyon, hematüri, kök hücre nakli, lenfoma, sistit

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

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,

PDF

___

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.