Clinical Outcomes following Percutaneous Urinary Diversion for Hemorrhagic Cystitis

Farhan, Ahmed; Lyons, Gray R.

doi:10.1016/j.jvir.2022.03.605

Cited by 1 publication

(1 citation statement)

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“…Success with diversion via percutaneous nephrostomy tubes is limited to small series. 107 , 108 A more definitive intervention comes in the form of a cystectomy with urinary diversion, which is typically a treatment of last resort given its invasive nature. This can typically be done with a simple cystectomy and an ileal or transverse colon conduit, taking care to choose bowel that is unaffected by prior radiation in those with a history of RT.…”

Section: Urinary Diversionmentioning

confidence: 99%

Hemorrhagic Cystitis: Making Rapid and Shrewd Clinical and Surgical Decisions for Improving Patient Outcomes

Jefferson¹,

Linder²

2023

RRU

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Hemorrhagic cystitis (HC) can be one of the most challenging clinical scenarios for urologists to manage. It most commonly occurs as a toxicity of pelvic radiation therapy or in patients treated with the oxazaphosphorine class of chemotherapy. Successful management of HC necessitates a stepwise approach with a thorough understanding of the various treatment options. Once ensuring hemodynamic stability, conservative management includes establishing bladder drainage, manual clot evacuation, and continuous bladder irrigation through a large-bore urethral catheter. If gross hematuria persists, operative cystoscopy with bladder clot evacuation is often required. There are multiple intravesical options for treating HC, including alum, aminocaproic acid, prostaglandins, silver nitrate, and formalin. Formalin is an intravesical option that has caustic effects on the bladder mucosa and is most often reserved as a last-line intravesical treatment. Non-intravesical management tools include hyperbaric oxygen therapy and oral pentosan polysulfate. If needed, nephrostomy tube placement or superselective angioembolization of the anterior division of the internal iliac artery can be performed. Finally, cystectomy with urinary diversion is a definitive, albeit invasive, treatment option for refractory HC. While there is no standardized algorithm, treatment modalities typically progress from less to more invasive. Clinical judgement and shared decision-making with the patient are required when choosing therapies for managing HC, as success rates are variable and some treatments may have significant or irreversible effects.

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Section: Urinary Diversionmentioning

confidence: 99%