Intravesical Formalin for Hemorrhagic Cystitis: Analysis of Therapy

Donahue, Laurence A.; Frank, Irwin N.

doi:10.1016/s0022-5347(17)41016-0

Cited by 90 publications

(54 citation statements)

References 26 publications

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“…19,20,21,22,23,24 Intravesical formalin instillation is performed under general or regional anesthesia once vesicoureteral reflux has been excluded. It causes precipitation of cellular proteins in the mucosa, producing an occlusive and fixative action on telangiectatic tissue and small capillaries.…”

Section: Formalinmentioning

confidence: 99%

Management of radiation cystitis

2010

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Acute radiation cystitis occurs during or soon after radiation treatment. It is usually self-limiting, and is generally managed conservatively. Late radiation cystitis, on the other hand, can develop from 6 months to 20 years after radiation therapy. The main presenting symptom is hematuria, which may vary from mild to severe, life-threatening hemorrhage. Initial management includes intravenous fluid replacement, blood transfusion if indicated and transurethral catheterization with bladder washout and irrigation. Oral or parenteral agents that can be used to control hematuria include conjugated estrogens, pentosan polysulfate or WF10. Cystoscopy with laser fulguration or electrocoagulation of bleeding points is sometimes effective. Injection of botulinum toxin A in the bladder wall may relieve irritative bladder symptoms. Intravesical instillation of aluminum, placental extract, prostaglandins or formalin can also be effective. More-aggressive treatment options include selective embolization or ligation of the internal iliac arteries. Surgical options include urinary diversion by percutaneous nephrostomy or intestinal conduit, with or without cystectomy. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at higher than atmospheric pressure. The reported success rate of HBOT for radiation cystitis varies from 60% to 92%. An important multicenter, doubleblind, randomized, sham-controlled trial to evaluate the effectiveness of HBOT for refractory radiation cystitis is currently being conducted.

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Section: Formalinmentioning

confidence: 99%

Management of radiation cystitis

2010

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“…[14][15][16] Few have shown an encouraging effect with acceptable side-effects. Case reports about oral estrogen as an effective treatment of HC have prompted us to try this modality in affected patients.…”

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confidence: 99%

Encouraging results in the treatment of haemorrhagic cystitis with estrogen – report of 10 cases and review of the literature

Ordemann

Naumann

Geissler

et al. 2000

Bone Marrow Transplant

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Summary:Haemorrhagic cystitis (HC) after allogeneic haematopoietic stem cell transplantation (HSCT) or high-dose cyclophosphamide (CP) chemotherapy is a severe sideeffect and can cause significant morbidity and mortality. In this report, we describe the clinical courses of 10 patients with HC and review the literature. The patients were treated with oral conjugated estrogen in an attempt to improve severe haemorrhagic cystitis. In seven patients positive effects were seen, haematuria resolved in all, but residual symptoms of dysuria remained for longer periods. In one patient application of estrogen was interrupted because of hepatotoxicity. Two patients failed all treatment modalities including oral estrogen because of terminal illness. We conclude that in the management of HC the administration of oral conjugated estrogen should be considered. Bone Marrow Transplantation (2000) 25, 981-985.

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“…9,11,12,[15][16][17] In their comprehensive review of the 235 previously reported cases of formalin use, Donahue and Frank (1989) identified a trend towards increasing complete response rates with 10% intravesical formalin (83% complete response), as compared to 5% formalin (78% complete response) or 1% formalin (71% complete response) solutions, although this was not statistically significant. 16 Here, we identified a success rate of 63% at a median followup of eight months with the initial use of 1% formalin. Notably, dose escalation to 4% was used in only one patient.…”

Section: Discussionmentioning

confidence: 99%

Intravesical formalin for hemorrhagic cystitis: A contemporary cohort

Ziegelmann

Boorjian

Joyce

et al. 2017

CUAJ

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Introduction: Hemorrhagic cystitis presents a difficult clinical challenge, yet data regarding treatment options is sparse. Here, we sought to evaluate outcomes of a contemporary cohort of patients treated with intravesical formalin for hemorrhagic cystitis.Methods: We identified a retrospective cohort of eight patients managed with formalin for hemorrhagic cystitis from 2000‒2014. All patients failed prior measures, including bladder irrigation, clot evacuation, and other intravesical agents. Treatment success was defined as hematuria resolution during the given hospitalization without use of additional invasive therapies. We also evaluated treatment complications and additional treatments following hospital dismissal.Results: Etiology of cystitis was radiation for malignancy in all cases. The formalin concentration ranged from 1‒4%, with escalation used in treatment failures. Five patients (62.5%) received a single dose of 1% formalin, two patients received two doses, and one patient received three doses. Notably, intraoperative cystography identified vesicoureteral reflux (VUR) in 50.0% of patients. Six patients (75.0%) achieved treatment success, with a median time to resolution of four days (range 1‒17 days). Of those refractory to formalin, one was managed with indwelling nephrostomy tubes and one underwent cystectomy. Median followup was eight months. Of the responders, two eventually required cystectomy, one for recurrent hematuria and one for recalcitrant bladder neck contracture and bladder dysfunction. The remaining four patients (50%) required no additional therapy.Conclusions: Formalin remains an important tool for treating refractory hemorrhagic cystitis, with roughly 75.0% of patients requiring no additional therapy prior to hospital discharge. Notably, there is a risk of bladder dysfunction following formalin.

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Intravesical Formalin for Hemorrhagic Cystitis: Analysis of Therapy

Cited by 90 publications

References 26 publications

Management of radiation cystitis

Management of radiation cystitis

Encouraging results in the treatment of haemorrhagic cystitis with estrogen – report of 10 cases and review of the literature

Intravesical formalin for hemorrhagic cystitis: A contemporary cohort

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