Hemorrhagic cystitis

Hemorrhagic cystitis or Haemorrhagic cystitis is diffuse inflammation of the bladder leading to dysuria, hematuria, and hemorrhage. This is seen most often in female cancer patients as a complication of therapy, however it is can also be seen in children as a result of viral infection. In the case of a viral infection, it is classified as a urinary tract infection.

Causes

Causes of hemorrhagic cystitis include chemotherapy (e.g. cyclophosphamide,methotrexate), radiation, or viral infection. Adenovirus (particularly serotypes 11 and 21 of subgroup B) is the most common cause of acute viral hemorrhagic cystitis in children, though it can result from BK virus as well.

Diagnosis

Diagnosis is made by history and examination.

In immunocompromised patients, pus is present in the urine but often no organism can be cultured. In children, polymerase chain reaction sequencing of urine can detect fragments of the infectious agent.

Treatment

In the case of hemorrhagic cystitis from cyclophosphamide, this can be prevented through aggressive hydration and the use of mesna, which neutralizes the toxicity of acrolein, a metabolite of cyclophosphamide.

Viral hemorrhagic cystitis in children generally spontaneously resolves within a few days.