Fatal complication of intravesical formalin during control of intractable hemorrhage from radiation cystitis

Use of Alum to Control Intractable Vesical Haemorrhage

“…Although bleeding ceases in over 80% of patients treated with formalin instillation (Fair, 1974;Shrom et a/., 1976) or balloon distension (Holstein e t a / . Although bleeding ceases in over 80% of patients treated with formalin instillation (Fair, 1974;Shrom et a/., 1976) or balloon distension (Holstein e t a / .…”

“…Blood loss may be considerable and to control it is often difficult, as indicated by the number of methods which have been reported. They are not always successful and complications including fatalities have been reported (Rao et al, 1978). The poor results from cystoscopy and diathermy (Lapides, 1970) have led to the instillation of such substances as formalin (Fair, 1974;Shrom er al., 1976), silver nitrate (Kumar er al., 1976) and phenol (Susan and Marsh, 1975).…”

Fatal Outcome of Intravesical Formalin Instillation, with Changes Mimicking Renal Tuberculosis

“…First of all, it is most likely that vesicoureteric reflux was present at the time of the first (or the second) formalin instillation. It should be stressed that not making a cystogram before every in travesical instillation of formalin [10,12] is an impor tant shortcoming, since reflux of formalin can cause fatal complications such as acute tubular necrosis [6,12,18,20], Secondly, vesicoureteric reflux can result from re peated transurethral resections of recurrent tumors dam aging the antireflux mechanism of the vesicoureteric junction. On the other hand, reflux can also be induced by a previous formalin instillation [7], In our case, exten sive hydronephrosis -irrespective of a possible vesico ureteric reflux -might also be the result of a contracted fibrotic bladder and bilateral ureterovesical junction ob struction [24], The presence of fibrotic changes in the retroperitoneum and ureters suggests that reflux of for malin had occurred into the upper tracts.…”

“…In travesical formalin (37.8% formaldehyde), used by Brown for the first time in 1969, is an alternative therapy for this devasting complication and has become estab lished as a valuable method [2,5,[7][8][9]22]. However, it has now become evident that serious complications may be encountered and the following have been reported: small contracted bladder, vesicoureteric reflux, ureteric fibrosis, ureterovesical junction obstruction with hydroureteronephrosis, and even death secondary to acute tubular necrosis [6,12,18,20,24], This latter phenom enon may be the direct result of formalin entry into the kidney, due to acquired vesicoureteric reflux. The fre quency and the seriousness of these complications de pend largely on the concentration of the formalin solu tion used [7,8].…”

The management of cyclophosphamide‐induced haematuria

“…Other regimens have used differing concentrations for varying lengths of time. Unfortunately the higher concentrations and higher duration of treatment have been associated with several side-effects, ranging from ureteric fibrosis, anuria and incontinence, to acute tubular necrosis leading to renal failure and death [18,[22][23][24].…”