Introduction

Gross hematuria requiring blood transfusion is uncommon, and few studies have evaluated management or long term outcomes after initial surgical treatment. Here, we characterize patients undergoing surgical management of transfusion dependent hematuria and evaluate post-surgical outcomes. We hypothesized that patients who had received prior pelvic radiation would have worse postoperative outcomes.

Methods

Following IRB approval, comprehensive clinical information was collected and analyzed for patients with hematuria requiring blood transfusion and inpatient surgical management from 2000-2015.

Results

Seventy patients requiring surgery for transfusion dependent hematuria were identified, including 30 (42.9%) who had received prior pelvic radiation. Hematuria was due to radiation cystitis in 20 (28.6%), post operative bleeding in 12 (17.1%), traumatic catheterization in 10 (14.3%), benign prostatic bleeding in 6 (8.57%), bladder cancer in 5 (7.14%), prostate cancer in 5 (7.14%), hemorrhagic cystitis in 4 (5.71%), and other causes in 8 (11.4%) patients._x000D_ _x000D_ All 70 patients underwent cystoscopy with clot evacuation and fulguration. Concomitant operations performed included formalin instillation in 7, TURBT in 8, suprapubic tube placement in 4, and ligation of the bulbar arteries in 1 patient(s). _x000D_ _x000D_ Radiated patients were on average 9.3 years older than their non-radiated counterparts (p=0.01). Otherwise no significant differences were identified in baseline characteristics or with regards to LOS, 90 day readmission rate, or likelihood of indwelling catheterization at discharge (Table). _x000D_ _x000D_ At median follow up of 10.9 (IQR 3.7-26.5) months, radiated patients required on average 1.9 additional surgical procedures compared to 1.4 without prior radiation (p=0.21). Previously radiated patients were more likely to require long term urinary diversion compared to non-radiated patients, 9 (31.0%) versus 3 (8.3%) patients (p=0.02)._x000D_

Conclusions

Pelvic radiation is a common etiology for transfusion dependent hematuria. While initial post-operative outcomes were similar, one third of patients with transfusion dependent hematuria and prior radiation required urinary diversion for long term management.

Funding

none