Formalin treatment for intractable hemorrhagic cystitis.A review of the literature with 16 additional cases

Abstract

Acute, exsanguinating hemorrhagic cystitis secondary to cyclophosphamide therapy, radiation therapy, or an infiltrating bladder tumor may be managed successfully with intravesical Formalin therapy. The indications for its use, the technique, success rates, and complications are discussed. This treatment was effective in 14 of 16 patients in the present series and 79 of 90 cases reported in the literature. Dilutions of 4% or less were as effective as a 10% dilution and were associated with far fewer complications. The early use of Formalin in the treatment of intractable hemorrhagic cystitis is recommended.

Treatment of Hemorrhagic Radiation Proctitis With 4 Percent Formalin

“…16 Formalin therapy for radiation cystitis was described by Shrom et al 17 in 1976. Rubinstein then successfully used formalin to treat radiation proctitis based on the success in radiation cystitis.…”

“…16 Since then, it has been used successfully for hemorrhagic cystitis [16][17][18] and was eventually tried in the treatment of hemorrhagic radiation proctitis in 1986 by Rubinstein and colleagues, 19 where one patient was treated with formalin instillation and did not rebleed during 14 months of followup. Sporadic reports have appeared in the literature describing more patients and more refined techniques for the use of formalin in the rectum.…”

Prevention and management of BK‐virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation – a systematic review and evidence‐based guidance for clinical management

“…Highly toxic, high rate of complications, systemic toxicity D 3 (Shrom et al, 1976;Redman & Kletzel, 1994;Cheuk et al, 2007) Silver nitrate Instillation (Helmstein, 1972;England et al, 1973;Hammonds et al, 1974;Hansen et al, 1976) Cystostomy/ cystectomy (Ordemann et al, 2000). Side effects were rare, although cases of hepatosis requiring treatment withdrawal have been reported (Ordemann et al, 2000).…”

“…One of those used irrigation of the bladder with 4% formalin for 10-20 min for HC in the HSCT setting (Cheuk et al, 2007); the other two (Shrom et al, 1976) (Redman & Kletzel, 1994) used 4% formalin instillation for postchemotherapy HC. All achieved high remission rates (4/5, 3/3 and 5/6 patients, respectively).…”

Management of chronic hemorrhagic radiation proctitis

“…Shrom et al proposed that it might hydrolyze proteins and superficially coagulate tissue. 37 It has its own disadvantages such as the need for general or regional anesthesia and local complications in the form of anal ulceration, fissure and worsening of radiation-induced strictures. Also it cannot be used for hemorrhagic lesions in sigmoid colon.…”