Related Experiment Video
Updated: Mar 24, 2026
Modeling Posthemorrhagic Hydrocephalus of Prematurity in Rats
Published on: March 28, 2025
Risk Factors Associated with Severity and Outcomes in Pediatric Patients with Hemorrhagic Cystitis
Derrick Johnston1, Elleson Schurtz1, Elizabeth Tourville1
1Division of Urology, Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Pediatric Urology, Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
Hemorrhagic cystitis in children treated for cancer can be severe. Pelvic radiation and delayed onset are key risk factors for higher grade disease and invasive treatment needs.
Area of Science:
- Pediatric Oncology
- Urology
- Cancer Treatment Complications
Background:
- Hemorrhagic cystitis (HC) is a significant complication in pediatric cancer treatment.
- HC severity and morbidity vary widely, impacting patient outcomes.
Purpose of the Study:
- To analyze the severity and treatment outcomes of HC in a large pediatric population.
- To identify risk factors associated with HC severity and the need for invasive management.
Main Methods:
- Retrospective analysis of 285 pediatric patients with HC treated between 1990 and 2010.
- Data collection included demographics, cancer diagnosis, HC treatment, and mortality.
- Statistical analyses evaluated associations between risk factors, HC severity, and treatment outcomes.
Main Results:
- Pelvic radiation therapy, bone marrow transplantation, and certain chemotherapies (cyclophosphamide, ifosfamide) were associated with higher HC grade and invasive management.
- Male gender and BK virus positivity were also identified as risk factors.
- Multivariate analysis confirmed pelvic radiation and delayed HC onset as independent predictors of severity.
Conclusions:
- Identifiable risk factors correlate with HC severity and noninvasive treatment failure.
- Prospective identification of high-risk patients may enable targeted early interventions to improve outcomes.
Purpose:
Hemorrhagic cystitis is a complication of treatment of pediatric cancer with considerable variation in severity and morbidity. This study presents an analysis of hemorrhagic cystitis severity and treatment outcomes in a large pediatric population.
Materials And Methods:
Patients with hemorrhagic cystitis treated at St. Jude Children's Research Hospital® were identified from 1990 to 2010. Demographic data were gathered along with information pertaining to initial primary diagnosis, hemorrhagic cystitis diagnosis and treatment, and mortality. Statistical analyses were performed to evaluate associations between risk factors and severity of hemorrhagic cystitis as well as treatment outcomes.
Results:
Of the 285 patients who met inclusion criteria 54% were male. Mean age was 11.41 years. Mean time from initial primary diagnosis to hemorrhagic cystitis onset was 29 months. Noninvasive treatment was performed in 246 patients (86%) and operative intervention was required in 14 (4.9%). Bivariate analysis demonstrated that pelvic radiation therapy (p = 0.0002), any radiation therapy (p = 0.005), acute lymphocytic leukemia (p = 0.01), bone marrow transplantation (p = 0.0225), cyclophosphamide exposure (p = 0.0419) and BK virus positivity (p = 0.0472) were predictors of higher grade hemorrhagic cystitis. Factors correlating with the need for invasive management on bivariate analysis included pelvic radiation therapy (p = 0.0266), bone marrow transplantation (p = 0.0007), hematological malignancy (p = 0.0066), ifosfamide exposure (p = 0.0441) and male gender (p = 0.0383). Multivariate analysis showed independent effects of pelvic radiation therapy (p = 0.001) and delayed onset of hemorrhagic cystitis (p = 0.0444).
Conclusions:
Severity of hemorrhagic cystitis and failure of noninvasive management correlate with several identifiable risk factors. Prospective identification of patients with these risk factors may allow for targeted early intervention in those at highest risk.
Related Concept Videos
01:25Urinary Tract Infection II: Pathophysiology
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:27Acute Pyelonephritis I: Introduction
01:26Urinary Tract Infection I: Introduction
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption