SUPRAPUBIC CYSTOTOMY AS TREATMENT FOR SEVERE HEMORRHAGIC CYSTITIS AFTER BONE-MARROW TRANSPLANTATION

We analyzed the success of suprapubic cystotomy in patients with sever e hemorrhagic cystitis after bone marrow transplantation. Seventy-thre e out of 963 patients developed severe hemorrhagic cystitis which resu lted in urinary tract obstruction after high-dose cytoreductive therap y. Eleven patients (15%) failed medical treatment and required emergen cy suprapubic cystotomy, Three of these patients died of other complic ations prior to resolution of HC. Of the remaining 8 patients who unde rwent surgery, 4 are alive. The mortality rate was significantly highe r in patients who required surgery than in those who responded to medi cal therapy. Patients whose HC required surgery also had a greater tra nsfusion requirement than those who responded to medical therapy. We c onclude that surgical treatment of severe HC should be undertaken only after failure of medical therapy.