Formalin treatment of refractory hemorrhagic cystitis in systemic lupus erythematosus

Abstract

Hemorrhagic cystitis is a potentially life-threatening complication in systemic lupus erythematosus (SLE). No safe, effective and conservative treatment exists for patients who fail to respond to standard therapy. We report a 17-year-old girl with SLE who suffered from severe hemorrhagic cystitis. Initially, she received frequent red blood cell and platelet transfusions, continuous bladder irrigation, and blood clots were evacuated. Numerous kinds of treatment were tried, including electrocoagulation of bleeding foci, prostaglandin E1 bladder instillation, and hyperbaric oxygen. However, she remained severely anemic and thrombocytopenic necessitating daily transfusions of blood products. After intravesical formalin instillation was performed twice, the hematuria ceased completely.

Genitourinary complications of systemic lupus erythematosus

“…Cyclophosphamide-induced hemorrhagic cystitis is often temporally related to therapy. Removal of the offending agent is often sufficient, but severe hemorrhage may require use of locally instilled therapy [17,25]. How can one differentiate SLE cystitis from a culturenegative viral cystitis?…”

Life‐threatening hemorrhage from enterotomies and anastomoses in 7 horses

“…23 Formalin had been used successfully in humans for control of rectal hemorrhage in association with pelvic malignancies, malignant ulcers, and hemorrhagic cystitis. [24][25][26][27] In healthy horses, however, IV administration of formalin did not have a detectable effect on measured hemostatic variables. 28 It was noted that the vasoconstrictive response to profound hypovolemia may enhance effects of formalin infusion, and this may explain a lack of effect in hemodynamically normal horses.…”

“…The use of formalin to control profuse hemorrhage in horses was first reported by Roberts in 1943, 22 and there is much anecdotal testimony to support its use in horses for this purpose 23 . Formalin had been used successfully in humans for control of rectal hemorrhage in association with pelvic malignancies, malignant ulcers, and hemorrhagic cystitis 24‐27 . In healthy horses, however, IV administration of formalin did not have a detectable effect on measured hemostatic variables 28 .…”

Canadian Urological Association Best-Practice Report: Pediatric hemorrhagic cystitis

“…Other case reports have documented success with lower concentrations such as 1% and 2%, though often with repeated courses of therapy needed. 20,53 Alternatively, cystotomy with application of 4% formalin soaked swabs or endoscopic placement of formalin soaked pledgets have also been reported in cases. 52 Silver nitrate irrigation has also been used to treat HC, but is notable for bladder fibrosis and contracture.…”