https://doi.org/10.4081/aiua.2021.2.200

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

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
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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.

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How to Cite

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

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