In an extensive search of the literature 235 cases of intractable hemorrhagic cystitis treated with intravesical formalin were identified. Effectiveness of therapy, rate of recurrence of hematuria, morbidity and mortality were analyzed with respect to concentration of formalin and to the etiology of hematuria. Increasing concentrations of formalin slightly improved effectiveness of therapy and reduced the rate of recurrence of hematuria. However, this often resulted in an increase in morbidity. When patients were categorized according to the etiology of intractable hematuria it was noted that lower concentrations of formalin were effective in controlling hematuria caused by either cyclophosphamide cystitis or unresectable carcinoma of the bladder. In contrast, higher formalin concentrations were required to control bleeding due to radiation cystitis.

OBJECTIVE To report the management of urachal anomalies using a robotically assisted approach. PATIENTS AND METHODS Between January 2005 and February 2006, five patients (mean age 51 years, range 24–68) were diagnosed with urachal anomalies. Two basic robot‐assisted surgical approaches were used for excising the urachal anomalies: excision of the urachal remnant via partial cystectomy, and radical cystectomy for excision of urachal adenocarcinoma. RESULTS All five cases were successful and the excised specimens were assessed histologically. The short‐term oncological outcome in the three patients with histologically confirmed moderately differentiated adenocarcinoma showed no evidence of recurrent disease within a median interval of 8 months. Surveillance follow‐up cystoscopy in the patients who had a partial cystectomy showed a well‐healed bladder mucosa with no evidence of recurrence. CONCLUSIONS Radical excision of the urachal tract with partial cystectomy or radical cystectomy using the da Vinci robot is safe, effective and technically feasible.

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A patient with life-threatening retroperitoneal hemorrhage after extracorporeal shock wave lithotripsy is presented. Despite angioinfarction of the involved renal unit, nephrectomy ultimately was required to control bleeding. The urological and hematological aspects of the management are discussed.

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