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Clinical Outcomes following Percutaneous Urinary Diversion for Hemorrhagic Cystitis

Ahmed Farhan1, Gray R Lyons1

  • 1Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

Journal of Vascular and Interventional Radiology : JVIR
|July 1, 2022
PubMed

Insights

Percutaneous nephrostomy (PCN) drainage offers a safe and effective treatment for severe hemorrhagic cystitis (HC). This procedure provides urinary diversion, leading to significant hematuria resolution and reduced symptom severity in refractory cases.

Area of Science:

  • Urology
  • Interventional Radiology

Background:

  • Hemorrhagic cystitis (HC) presents significant morbidity, especially in treatment-refractory cases.
  • Percutaneous nephrostomy (PCN) drainage was established in 1993 for supravesical urinary diversion in severe HC.
  • Limited adult studies exist on long-term PCN outcomes for refractory HC.

Purpose of the Study:

  • To evaluate the long-term effectiveness and safety of PCN placement in adult patients with refractory hemorrhagic cystitis.
  • To assess the impact of PCN on hematuria resolution and HC severity.

Main Methods:

  • Retrospective case series of 24 adult patients with refractory HC.
  • Analysis of technical success, hematuria resolution rates, time to resolution, and changes in HC severity grade.
  • Documentation of procedural and catheter-related complications.

Main Results:

  • 100% technical success rate for PCN placement.
  • 71% of patients (17/24) achieved hematuria resolution, with a median resolution time of 12 days.
  • Significant decrease in HC severity grade post-procedure (median Grade 3 to Grade 1, P < .01).
  • Low complication rates for catheter obstruction (1.0), dislodgement (1.6), and UTIs (1.7) per 1,000 catheter days.

Conclusions:

  • PCN placement is a highly effective and safe intervention for achieving urinary diversion in refractory HC.
  • The procedure leads to substantial improvement in patient outcomes, including hematuria control and reduced disease severity.
  • PCN drainage represents a valuable nonoperative option for managing severe, treatment-resistant hemorrhagic cystitis.

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