PROSTAGLANDIN-E2 BLADDER INSTILLATION FOR THE TREATMENT OF HEMORRHAGIC CYSTITIS AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Background. Hemorrhagic cystitis (HC) is a major complication of high- dose cyclophosphamide therapy used in the preparative regimen for allo geneic or autologous bone marrow transplantation. Several viruses (ade novirus, cytomegalovirus and polyomavirus BK) have also been implicate d in the etiology of HC. No one established method of treatment is as yet available. Materials and Methods. KC developed in 10 patients afte r allogeneic bone marrow transplantation and was BK viruria-associated in all cases. All patients were treated with instillations of prostag landin E2 (PGE2) directly into the bladder. Results. A complete resolu tion of hematuria within a short time (5 +/- 1 days) was observed in a ll cases; in 4/10 patients urine cleared within 24 hours of the initia l treatment. Intravesical PGE2 therapy caused no systemic circulatory or respiratory problems, although bladder spasms occurred in all patie nts. Conclusions. Intravesical prostaglandin E2 instillation appears t o be an effective treatment for hemorrhagic cystitis in bone marrow tr ansplant patients; further studies are required ti, assess the actual role of BK virus in the pathogenesis of HC in bone marrow transplant p atients.