Геморрагический цистит (ГЦ) в структуре воспалительных заболеваний нижних мочевых путей составляет от 5 до 10%, в последнее время наметилась тенденция увеличения числа больных с указанным заболеванием. ГЦ может являться осложнением противоопухолевой химио- или лучевой терапии у пациентов со злокачественными опухолями органов малого таза. Однако наиболее часто ГЦ возникает у женщин, страдающих хронической герпес-вирусной инфекцией. Учитывая многообразие этиологических факторов, приводящих к возникновению ГЦ, имеют место различные патофизиологические механизмы развития заболевания, что требует индивидуального подхода, разработки алгоритмов обследования и ведения указанных пациентов. Статья включает обзор зарубежных и отечественных научных публикаций, посвященных эпидемиологии, этиологии, патогенезу и диагностике ГЦ.
Ключевые слова: геморрагический цистит, лучевая терапия, химиотерапия, циклофосфамид, полиомавирусы, вирус простого герпеса 1 и 2-го типа.
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Hemorrhagic cystitis (HC) in the structure of inflammatory diseases of the lower urinary tract occupies from 5 to 10%, and recently there has been a tendency to increase the number of patients with this disease. HC may be a complication of antitumor chemo- or radiation therapy in patients with malignant tumors of the pelvic organs. However, the most common HC occurs in women with chronic herpes-viral infection. Given the variety of etiological factors leading to the onset of HC, various pathophysiological mechanisms of the disease development take place, which requires an individual approach, the development of examination algorithms and the management of these patients. The article includes a review of foreign and domestic scientific publications on the epidemiology, etiology, pathogenesis and diagnosis of HC.
Key words: hemorrhagic cystitis, radiation therapy, chemotherapy, cyclophosphamide, polyomaviruses, herpes simplex virus type 1 and type 2.
1. Haldar S, Dru C, Bhowmick NA. Mechanisms of hemorrhagic cystitis. Am J Clin Exp Urol 2014; 2 (3): 199–208.
2. Manikandan R, Kumar S, Lalgudi N. Dorairajan, Hemorrhagic cystitis: A challenge to the urologist. Indian J Urol 2010; 26 (2): 159–66.
3. Basler J, Kim E. Hemorrhagic Cystitis. Medscape, 2016.
4. Crew JP, Jephcott CR, Reynard JM. Radiation-induced haemorrhagic cystitis. Eur Urol 2001; 40 (2): 111–23.
5. Chong KT, Hampson NB, Corman JM. Early hyperbaric therapy improves outcome for radiation-induced hemorrhagic cystitis. Urology 2005; 65: 649–53.
6. Liem X, Saad F, Delouya G. A Practical Approach to the Management of Radiation-Induced Hemorrhagic Cystitis. Drugs 2015; 75 (13): 1471–82.
7. Boyle P, Levin B. World cancer report. Lyon: IARC Press, 2008.
8. Denton AS, Clarke N, Maher J. Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev 2002; CD001773.
9. Levenback C, Eifel PJ, Burke TW et al. Hemorrhagic cystitis following radiotherapy for stage Ib cancer of the cervix. Gynecol Oncol 1994; 55 (2): 206–10.
10. Palou J, Pisano F, Esquena S et al. Natural history and predictive factors for hospitalization in patients with radiation cystitis. Results from a large retrospective study. J Urol 2016; 195 (Suppl. 4): e956–e957.
11. Korkmaz A, Topal T, Oter S. Pathophysiological aspects of cyclophosphamide and ifosfamide induced hemorrhagic cystitis; implication of reactive oxygen and nitrogen species as well as PARP activation. Cell Biol Toxicol 2007; 23: 303–12.
12. Islam R, Issacson BJ, Zickerman PM et al. Hemorrhagic cystitis as an unexpected adverse reaction to temozolomide: Case report. Am J Clin Oncol 2002; 25: 513–4.
13. Marx CM, Alpert SE. Ticarcillin-induced cystitis. Cross reactivity with related pencillin. Am J Dis Child 1984; 138: 670–2.
14. Andriole GL, Brickman C, Lack EE et al. Danazol-induced cystitis: an undescribed source of hematuria in patients with hereditary angioneurotic edema. J Urol 1986; 135 (1): 44–6.
15. Naber KG et al. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. Eur Urol 2008; 54 (5): 1164–75.
16. Naber K, Scaeffer A, Heyns C et al. Urogenital Infections. 2010.
17. Erard V, Storer B, Corey L et al. BK virus infection in haematopoietic stem cell transplant receipents: Frequency, risk factors and association with post engraftment haemorrhagic cystitis. Clin Infect Dis 2004; 39: 1861–5.
18. Azzi A, Ciappi S, De Santis R et al. Hemorrhagic cystitis associated with BKV in patients with refractory acute lymphoblastic leukemia. Am J Hematol 1996; 52 (2): 121–2.
19. Azzi A, Fanci R, Bosi A et al. Monitoring of polyomavirus BK viruria in bone marrow transplantation patients by DNA hybridization assay and by polymerase chain reaction: an approach to assess the relationship between BK viruria and hemorrhagic cystitis. Bone Marrow Transplant 1994; 14 (2): 235–40.
20. Bedi A, Miller CB, Hanson JL et al. Association of BK virus with failure of prophylaxis against hemorrhagic cystitis following bone marrow transplantation. J Clin Oncol 1995; 13 (5): 1103–9.
21. Erard V, Kim HW, Corey L et al. BK DNA viral load in plasma: evidence for an association with hemorrhagic cystitis in allogeneic hematopoietic cell transplant recipients. Blood 2005; 106 (3): 1130–2.
22. Giraud G, Bogdanovic G, Priftakis P et al. The incidence of hemorrhagic cystitis and BK-viruria in allogeneic hematopoietic stem cell recipients according to intensity of the conditioning regimen. Haematologica 2006; 91 (3): 401–4.
23. Mylonakis E, Goes N, Rubin RH et al. BK virus in solid organ transplant recipients: an emerging syndrome. Transplantation 2001; 72 (10): 1587–92.
24. Mori Y, Miyamoto T, Kato K et al. Different risk factors related to adenovirus or BK virus-associated hemorrhagic cystitis following allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2011; 31.
25. Haines HL, Laskin BL, Goebel J et al. Blood, and not urine, BK viral load predicts renal outcome in children with hemorrhagic cystitis following hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2011; 17 (10): 1512–9.
26. Hoffman JA, Shah AJ, Ross LA, Kapoor N. Adenoviral infections and a prospective trial of cidofovir in pediatric hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2001; 7 (7): 388–94.
27. Hofland CA, Eron LJ, Washecka RM. Hemorrhagic adenovirus cystitis after renal transplantation. Transplant Proc 2004; 36 (10): 3025–7.
28. Ison MG. Adenovirus infections in transplant recipients. Clin Infect Dis 2006; 43 (3): 331–9.
29. Spach DH, Bauwens JE, Myerson D et al. Cytomegalovirus-induced hemorrhagic cystitis following bone marrow transplantation. Clin Infect Dis 1993; 16 (1): 142–4.
30. Tutuncuoglu SO, Yanovich S, Ozdemirli M. CMV-induced hemorrhagic cystitis as a complication of peripheral blood stem cell transplantation: case report. Bone Marrow Transplant 2005; 36 (3): 265–6.
31. Focosi D, Kast RE. Hyaluronate and risperidone for hemorrhagic cystitis. Bone Marrow Transplant 2007; 39 (1): 57.
32. McClanahan C, Grimes MM, Callaghan E, Stewart J. Hemorrhagic cystitis associated with herpes simplex virus. J Urol 1994; 151 (1): 152–3.
33. Nguyen ML, Borochovitz D, Thomas G et al. Hemorrhagic cystitis with herpes simplex virus type 2 in the bladder mucosa. Clin Infect Dis 1992; 14 (3): 767–8.
34. Uhm J, Hamad N, Michelis FV et al. The risk of polyomavirus BK-associated hemorrhagic cystitis after allogeneic hematopoietic SCT is associated with myeloablative conditioning, CMV viremia and severe acute GVHD. Bone Marrow Transplant 2014; 49 (12).
35. Lunde LE, Dasaraju S, Cao Q et al. Hemorrhagic cystitis after allogeneic hematopoietic cell transplantation: risk factors, graft source and survival. Bone Marrow Transplant 2015; 13.
36. Gorczynska E, Turkiewicz D, Rybka K et al. Incidence, clinical outcome, and management of virus-induced hemorrhagic cystitis in children and adolescents after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2005; 11 (10): 797–804.
37. Smit SG, Heyns CF. Management of radiation cystitis. Nat Rev Urol 2010; 7: 206–14.
38. Payne H, Adamson A, Bahl A et al. Chemical and radiation induced haemorrhagic cystitis: current treatments and challenges. BJU Int 2013; 112: 885–97.
39. Corman JM, McClure D, Pritchett R et al. Treatment of radiation induced hemorrhagic cystitis with hyperbaric oxygen. J Urol 2003; 169 (6): 2200–2.
40. Zwaans BM, Chancellor MB, Lamb LE. Modeling and treatment of radiation cystitis. Urology 2015; DOI: 10.1016/j.urology.2015.11.001
41. Schoenike SE, Dana WJ. Ifosfamide and mesna. Clin Pharm 1990; 9: 179–91.
42. Ribeiro RA, Freitas HC, Campos MC et al. Tumor necrosis factor-alpha and interleukin-1 beta mediate the production of nitric oxide involved in the pathogenesis of ifosfamide induced hemorrhagic cystitis in mice. J Urol 2002; 167: 2229–34.
43. Korkmaz A, Topal T, Oter S. Pathophysiological aspects of cyclophosphamide and ifosfamide induced hemorrhagic cystitis; implication of reactive oxygen and nitrogen species as well as PARP activation. Cell Biol Toxicol 2007; 23: 303–12.
44. Gomes TN, Santos CC, Souza-Filho MV et al. Participation of TNF-alpha and IL-1 in the pathogenesis of cyclophosphamide-induced hemorrhagic cystitis. Braz J Med Biol Res 1995; 28: 1103–8.
45. Beckman JS, Koppenol WH. Nitric oxide, superoxide, and peroxynitrite: the good, the bad, and ugly. Am J Physiol 1996; 271: 1424–37.
46. Kimura M, Tomita Y, Morishita H, Takahashi K. Presence of mucosal change in the urinary bladder in non hematuria patients with long-term exposure and/or accumulating high-dose cyclophosohamide. Possible significance of follow-up cystoscopy on preventing development of cyclophosphamide-induced hemorrhagic cystitis. Urol Int 1998; 61: 8–11.
47. Krane DM, Levine LA. Hemorrhagic cystitis. AUA Update Series 1992; XI: Lesson 31.
48. Амвросьева Т.В., Дедюля К.Л., Поклонская Н.В., Богуш З.Ф. Полиомавирусная инфекция человека: значение в патологии и генодиагностика. Здравоохранение. 2014; 10. / Amvros'eva T.V., Dediulia K.L., Poklonskaia N.V., Bogush Z.F. Poliomavirusnaia infektsiia cheloveka: znachenie v patologii i genodiagnostika. Zdravookhranenie. 2014; 10. [in Russian]
49. Скрябин Г.Н., Александров В.П., Кореньков Д.Г., Назаров Т.Н. Циститы. Учебн. пособие. СПб., 2006. / Skriabin G.N., Aleksandrov V.P., Koren'kov D.G., Nazarov T.N. Tsistity. Uchebn. posobie. SPb., 2006. [in Russian]
50. Исаков В.А., Архипова Е.И., Исаков Д.В. Герпесвирусные инфекции человека. 2011. / Isakov V.A., Arkhipova E.I., Isakov D.V. Gerpesvirusnye infektsii cheloveka. 2011. [in Russian]
51. Talar-Williams C, Hijazi YM, Walther MM et al. Cyclophosphamide-induced cystitis and bladder cancer in patients with Wegener′s granulomatosis. Ann Intern Med 1996; 124: 477–84.
52. Droller MJ, Saral R, Santos G. Prevention of cyclophosphamide-induced hemorrhagic cystitis. Urology 1982; 20: 256–8.
53. Radcliffe K, European STD Guidelines, 2004.
54. Paduch DA. Viral lower urinary tract infections. Curr Urol Rep 2007; 8: 324–35.
55. Zaleska-Dorobisz U, Biel A, Sokołowska-Dąbek D et al. Ultrasonography in the diagnosis of hemorrhagic cystitis – a complication of bone marrow transplantation in pediatric oncology patients. J Ultrason 2014; 14 (58): 258–72.
56. Epstein J, Reuter V, Amin M. Biopsy Interpretation of the Bladder. 2nd edition, 2011.
________________________________________________
1. Haldar S, Dru C, Bhowmick NA. Mechanisms of hemorrhagic cystitis. Am J Clin Exp Urol 2014; 2 (3): 199–208.
2. Manikandan R, Kumar S, Lalgudi N. Dorairajan, Hemorrhagic cystitis: A challenge to the urologist. Indian J Urol 2010; 26 (2): 159–66.
3. Basler J, Kim E. Hemorrhagic Cystitis. Medscape, 2016.
4. Crew JP, Jephcott CR, Reynard JM. Radiation-induced haemorrhagic cystitis. Eur Urol 2001; 40 (2): 111–23.
5. Chong KT, Hampson NB, Corman JM. Early hyperbaric therapy improves outcome for radiation-induced hemorrhagic cystitis. Urology 2005; 65: 649–53.
6. Liem X, Saad F, Delouya G. A Practical Approach to the Management of Radiation-Induced Hemorrhagic Cystitis. Drugs 2015; 75 (13): 1471–82.
7. Boyle P, Levin B. World cancer report. Lyon: IARC Press, 2008.
8. Denton AS, Clarke N, Maher J. Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev 2002; CD001773.
9. Levenback C, Eifel PJ, Burke TW et al. Hemorrhagic cystitis following radiotherapy for stage Ib cancer of the cervix. Gynecol Oncol 1994; 55 (2): 206–10.
10. Palou J, Pisano F, Esquena S et al. Natural history and predictive factors for hospitalization in patients with radiation cystitis. Results from a large retrospective study. J Urol 2016; 195 (Suppl. 4): e956–e957.
11. Korkmaz A, Topal T, Oter S. Pathophysiological aspects of cyclophosphamide and ifosfamide induced hemorrhagic cystitis; implication of reactive oxygen and nitrogen species as well as PARP activation. Cell Biol Toxicol 2007; 23: 303–12.
12. Islam R, Issacson BJ, Zickerman PM et al. Hemorrhagic cystitis as an unexpected adverse reaction to temozolomide: Case report. Am J Clin Oncol 2002; 25: 513–4.
13. Marx CM, Alpert SE. Ticarcillin-induced cystitis. Cross reactivity with related pencillin. Am J Dis Child 1984; 138: 670–2.
14. Andriole GL, Brickman C, Lack EE et al. Danazol-induced cystitis: an undescribed source of hematuria in patients with hereditary angioneurotic edema. J Urol 1986; 135 (1): 44–6.
15. Naber KG et al. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. Eur Urol 2008; 54 (5): 1164–75.
16. Naber K, Scaeffer A, Heyns C et al. Urogenital Infections. 2010.
17. Erard V, Storer B, Corey L et al. BK virus infection in haematopoietic stem cell transplant receipents: Frequency, risk factors and association with post engraftment haemorrhagic cystitis. Clin Infect Dis 2004; 39: 1861–5.
18. Azzi A, Ciappi S, De Santis R et al. Hemorrhagic cystitis associated with BKV in patients with refractory acute lymphoblastic leukemia. Am J Hematol 1996; 52 (2): 121–2.
19. Azzi A, Fanci R, Bosi A et al. Monitoring of polyomavirus BK viruria in bone marrow transplantation patients by DNA hybridization assay and by polymerase chain reaction: an approach to assess the relationship between BK viruria and hemorrhagic cystitis. Bone Marrow Transplant 1994; 14 (2): 235–40.
20. Bedi A, Miller CB, Hanson JL et al. Association of BK virus with failure of prophylaxis against hemorrhagic cystitis following bone marrow transplantation. J Clin Oncol 1995; 13 (5): 1103–9.
21. Erard V, Kim HW, Corey L et al. BK DNA viral load in plasma: evidence for an association with hemorrhagic cystitis in allogeneic hematopoietic cell transplant recipients. Blood 2005; 106 (3): 1130–2.
22. Giraud G, Bogdanovic G, Priftakis P et al. The incidence of hemorrhagic cystitis and BK-viruria in allogeneic hematopoietic stem cell recipients according to intensity of the conditioning regimen. Haematologica 2006; 91 (3): 401–4.
23. Mylonakis E, Goes N, Rubin RH et al. BK virus in solid organ transplant recipients: an emerging syndrome. Transplantation 2001; 72 (10): 1587–92.
24. Mori Y, Miyamoto T, Kato K et al. Different risk factors related to adenovirus or BK virus-associated hemorrhagic cystitis following allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2011; 31.
25. Haines HL, Laskin BL, Goebel J et al. Blood, and not urine, BK viral load predicts renal outcome in children with hemorrhagic cystitis following hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2011; 17 (10): 1512–9.
26. Hoffman JA, Shah AJ, Ross LA, Kapoor N. Adenoviral infections and a prospective trial of cidofovir in pediatric hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2001; 7 (7): 388–94.
27. Hofland CA, Eron LJ, Washecka RM. Hemorrhagic adenovirus cystitis after renal transplantation. Transplant Proc 2004; 36 (10): 3025–7.
28. Ison MG. Adenovirus infections in transplant recipients. Clin Infect Dis 2006; 43 (3): 331–9.
29. Spach DH, Bauwens JE, Myerson D et al. Cytomegalovirus-induced hemorrhagic cystitis following bone marrow transplantation. Clin Infect Dis 1993; 16 (1): 142–4.
30. Tutuncuoglu SO, Yanovich S, Ozdemirli M. CMV-induced hemorrhagic cystitis as a complication of peripheral blood stem cell transplantation: case report. Bone Marrow Transplant 2005; 36 (3): 265–6.
31. Focosi D, Kast RE. Hyaluronate and risperidone for hemorrhagic cystitis. Bone Marrow Transplant 2007; 39 (1): 57.
32. McClanahan C, Grimes MM, Callaghan E, Stewart J. Hemorrhagic cystitis associated with herpes simplex virus. J Urol 1994; 151 (1): 152–3.
33. Nguyen ML, Borochovitz D, Thomas G et al. Hemorrhagic cystitis with herpes simplex virus type 2 in the bladder mucosa. Clin Infect Dis 1992; 14 (3): 767–8.
34. Uhm J, Hamad N, Michelis FV et al. The risk of polyomavirus BK-associated hemorrhagic cystitis after allogeneic hematopoietic SCT is associated with myeloablative conditioning, CMV viremia and severe acute GVHD. Bone Marrow Transplant 2014; 49 (12).
35. Lunde LE, Dasaraju S, Cao Q et al. Hemorrhagic cystitis after allogeneic hematopoietic cell transplantation: risk factors, graft source and survival. Bone Marrow Transplant 2015; 13.
36. Gorczynska E, Turkiewicz D, Rybka K et al. Incidence, clinical outcome, and management of virus-induced hemorrhagic cystitis in children and adolescents after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2005; 11 (10): 797–804.
37. Smit SG, Heyns CF. Management of radiation cystitis. Nat Rev Urol 2010; 7: 206–14.
38. Payne H, Adamson A, Bahl A et al. Chemical and radiation induced haemorrhagic cystitis: current treatments and challenges. BJU Int 2013; 112: 885–97.
39. Corman JM, McClure D, Pritchett R et al. Treatment of radiation induced hemorrhagic cystitis with hyperbaric oxygen. J Urol 2003; 169 (6): 2200–2.
40. Zwaans BM, Chancellor MB, Lamb LE. Modeling and treatment of radiation cystitis. Urology 2015; DOI: 10.1016/j.urology.2015.11.001
41. Schoenike SE, Dana WJ. Ifosfamide and mesna. Clin Pharm 1990; 9: 179–91.
42. Ribeiro RA, Freitas HC, Campos MC et al. Tumor necrosis factor-alpha and interleukin-1 beta mediate the production of nitric oxide involved in the pathogenesis of ifosfamide induced hemorrhagic cystitis in mice. J Urol 2002; 167: 2229–34.
43. Korkmaz A, Topal T, Oter S. Pathophysiological aspects of cyclophosphamide and ifosfamide induced hemorrhagic cystitis; implication of reactive oxygen and nitrogen species as well as PARP activation. Cell Biol Toxicol 2007; 23: 303–12.
44. Gomes TN, Santos CC, Souza-Filho MV et al. Participation of TNF-alpha and IL-1 in the pathogenesis of cyclophosphamide-induced hemorrhagic cystitis. Braz J Med Biol Res 1995; 28: 1103–8.
45. Beckman JS, Koppenol WH. Nitric oxide, superoxide, and peroxynitrite: the good, the bad, and ugly. Am J Physiol 1996; 271: 1424–37.
46. Kimura M, Tomita Y, Morishita H, Takahashi K. Presence of mucosal change in the urinary bladder in non hematuria patients with long-term exposure and/or accumulating high-dose cyclophosohamide. Possible significance of follow-up cystoscopy on preventing development of cyclophosphamide-induced hemorrhagic cystitis. Urol Int 1998; 61: 8–11.
47. Krane DM, Levine LA. Hemorrhagic cystitis. AUA Update Series 1992; XI: Lesson 31.
48. Amvros'eva T.V., Dediulia K.L., Poklonskaia N.V., Bogush Z.F. Poliomavirusnaia infektsiia cheloveka: znachenie v patologii i genodiagnostika. Zdravookhranenie. 2014; 10. [in Russian]
49. Skriabin G.N., Aleksandrov V.P., Koren'kov D.G., Nazarov T.N. Tsistity. Uchebn. posobie. SPb., 2006. [in Russian]
50. Isakov V.A., Arkhipova E.I., Isakov D.V. Gerpesvirusnye infektsii cheloveka. 2011. [in Russian]
51. Talar-Williams C, Hijazi YM, Walther MM et al. Cyclophosphamide-induced cystitis and bladder cancer in patients with Wegener′s granulomatosis. Ann Intern Med 1996; 124: 477–84.
52. Droller MJ, Saral R, Santos G. Prevention of cyclophosphamide-induced hemorrhagic cystitis. Urology 1982; 20: 256–8.
53. Radcliffe K, European STD Guidelines, 2004.
54. Paduch DA. Viral lower urinary tract infections. Curr Urol Rep 2007; 8: 324–35.
55. Zaleska-Dorobisz U, Biel A, Sokołowska-Dąbek D et al. Ultrasonography in the diagnosis of hemorrhagic cystitis – a complication of bone marrow transplantation in pediatric oncology patients. J Ultrason 2014; 14 (58): 258–72.
56. Epstein J, Reuter V, Amin M. Biopsy Interpretation of the Bladder. 2nd edition, 2011.
Авторы
О.Б.Лоран*, Л.А.Синякова, Я.И.Незовибатько
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1 *olegloran@gmail.com
________________________________________________
O.B.Loran*, L.A.Sinyakova, Ya.I.Nezovibatko
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1 *olegloran@gmail.com