Death following Intravesical Formalin Instillation

The management of intractable haematuria

“…Formalin is an effective tool for controlling severe haematuria but serious complications may be encountered, and these potential complications should be known to the urologist when this treatment is contemplated. The complications of intravesical formalin include a small contracted bladder, urinary incontinence, VUR, ureteric strictures, vesico‐ureteric junction obstruction with hydroureteronephrosis, acute tubular necrosis with anuria, vesicovaginal fistula, vesico‐ileal fistula, a toxic effect on myocardium, and rupture of the bladder [23,25,26,28–33]. Fibrosis of the bladder, with reduced capacity and increased urinary frequency, is a common clinical sequel.…”

“…Bilateral ureterohydronephrosis may be attributed to obstruction of the vesico‐ureteric junctions by the fixative effect of formalin [23]. Five deaths have been reported [26,28,33–35]; the minimal lethal dose when ingested is 30 mg of 40% formalin solution [36], which equates to 120 mg of 10% formalin.…”

Biliary sclerosis following formalin instillation into hydatid cysts

“…The British Journal of Clinical Pra ctice, May 1988, Vol 42, No 5 sclerosis may be directly attributable to the use of formalin also comes from experiments in which sclerosis can be induced by instilling various formalin concentrations into the biliary tree of dogs", We conclude that the use of formalin is no longer justified in the treatment of hydatid disease when other equally effective and less toxic scolicidal agents, such as hypertonic saline, are available.…”

“…As well as the risks of tissue damage following the accidental spillage of formalin, there have been reports of fatal toxicity in patients who have had it instilled. Most cases have been of patients treated for bladder haemorrhage who, after the instillation of formalin into the bladder, developed circulatory collapse 5 , 6 . But this has occurred following formalin injection into hepatic hydatid cysts of nine patients 1 , 2 .…”