Formalin treatment for massive bladder hemorrhage

Intravesical Formalin for the Treatment of Massive Hemorrhagic Cystitis: Retrospective Review of 25 Cases

“…Other authors have used a similar amount of formalin [19]. The concentration of formalin (4%) used in 75% of fistulas after the instillation of formalin [12][13][14], In our experience, the uretero-hydronephrosis wors ened in 2 patients after the instillation and was explained as being secondary to meatal edema [11,29,32], If vesi coureteral reflux is present, the involved ureter must be catheterized to avoid injury to the upper urinary tract [20], In our series 40% of the cases corresponded to 'ex cluded' bladders where the danger of reflux is negli gible.…”

“…After completion of the instillation, the bladder must be washed out using a 10% alcohol solution [3], followed by a continuous bladder irrigation with normal saline [29]. Other authors have used a similar amount of formalin [19].…”

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

“…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. This latter probably led to stricture formation in the calyceal infun dibula, with ballooning of the calyces as seen in renal tuberculosis.…”

“…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].…”

Acute Tubular Necrosis following Intravesical Instillation of Formalin

“…Complications which have been reported to follow this procedure include transient tachycardia (5), hydro-ureteronephrosis secondary to ureterovesical junction obstruction (4,13), ureterovesical reflux (4,8), diminished bladder capacity and fibrosis of ureter (4), vesico-cutaneous fistula (8), bladder rupture (11), Bilateral papillary necrosis (7) and peritoneal extravasation and death (10). We would like to record a case who developed acute renal failure due to acute tubular necrosis following intravesical instillation of formalin.…”