Cyclophosphamide-induced bladder toxicity in wegener's granulomatosis

Authors

  • Thomas J. Stillwell MD,

    1. Department of Urology, Division of Thoracic Diseases and Internal Medicine, Department of Otorhinolaryngology, and Section of Surgical Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
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  • Ralph C. Benson Jr. MD,

    Corresponding author
    1. Department of Urology, Division of Thoracic Diseases and Internal Medicine, Department of Otorhinolaryngology, and Section of Surgical Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
    • Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224
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  • Richard A. Deremee MD,

    1. Department of Urology, Division of Thoracic Diseases and Internal Medicine, Department of Otorhinolaryngology, and Section of Surgical Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
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  • Thomas J. Mcdonald MD,

    1. Department of Urology, Division of Thoracic Diseases and Internal Medicine, Department of Otorhinolaryngology, and Section of Surgical Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
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  • Louis H. Weiland MD

    1. Department of Urology, Division of Thoracic Diseases and Internal Medicine, Department of Otorhinolaryngology, and Section of Surgical Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
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Abstract

In a series of 111 patients with Wegener's granulomatosis who were given cyclophosphamide therapy, hemorrhagic cystitis, diagnosed on the basis of gross hematuria or at cystoscopy (or both), developed in 17 (15%). Most of these patients recovered uneventfully, with or without the discontinuation of cyclophosphamide, but 4 patients suffered a significant loss of blood, and bladder carcinoma developed in 3. New microhematuria also occurred in 52 patients (47%). The dose and duration of cyclophosphamide were greater in the group that had urotoxicity. Long-term followup of patients with hemorrhagic cystitis is mandatory for the detection of late recurrences or the development of bladder malignancy. New therapies are being directed at protecting the bladder from urotoxicity during cyclophosphamide treatment.

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