Intractable Hematuria and Formalin

Abstract

Massive hematuria, which is most frequently caused by radiation for pelvic malignancies, after treatment with cyclophosphamide or secondary to aggressive anticoagulation, represents a vexing problem for the practicing urologist. The existence of numerous therapeutic approaches results from the lack of an effective therapeutic modality. Lately, formalin seems to offer a new hope for the treatment of intractable hematuria. Analysis of published results after treatment with formalin revealed generally excellent results regarding control of hematuria. Nevertheless, the complication rate of formalin application is surprisingly high, including vesicoureteral reflux and hydroureteronephrosis as local reactions and systemically tubular necrosis with anuria. Our series of patients is presented with a detailed description of a patient who was afflicted with a vesicovaginal fistula following formalin instillation. Formalin can serve as excellent therapy for massive hematuria. If attention is paid to the concentration and to the technical details of its instillation the noxious side effects can be minimized or prevented in the majority of cases.

Intravesical formalin for hemorrhagic cystitis: A contemporary cohort

“…9,11,12,[15][16][17] In their comprehensive review of the 235 previously reported cases of formalin use, Donahue and Frank (1989) identified a trend towards increasing complete response rates with 10% intravesical formalin (83% complete response), as compared to 5% formalin (78% complete response) or 1% formalin (71% complete response) solutions, although this was not statistically significant. 16 Here, we identified a success rate of 63% at a median followup of eight months with the initial use of 1% formalin.…”

“…12,16,18 From the limited available literature, it is clear that higher formalin concentrations are associated with an increased risk for adverse events. 12,16 Serious complication rates, as high as 50-75%, have been reported in patients undergoing 10% formalin instillation, albeit in small series. 11,15 For instance, in one series, 40% of patients required urinary diversion after intravesical formalin instillation for complications related to the procedure.…”

“…9,10 Since the initial report, multiple series have suggested a role for intravesical formalin in the treatment of refractory bladder hemorrhage, with reported success rates ranging from 70-90%, with variations in concentrations instilled and definitions of success. 9,11,12 Additionally, these reports are typically small series with limited followup, and represent historical cohorts. Therefore, we evaluated the clinical presentation, management, and outcomes of intravesical formalin in the setting of hemorrhagic cystitis in a contemporary cohort of patients.…”

Formalin treatment of refractory hemorrhagic cystitis in systemic lupus erythematosus

“…It probably is the most effective method for controlling massive hematuria and the most dangerous. Formalin causes precipitation of cellular proteins of the bladder mucosa [12]. It also acts through its occluding and fixative action upon telangiectatic tissue and small capillaries [12].…”

Radiation Induced Cystitis and Proctitis - Prediction, Assessment and Management

“…A contact period of 3-30 minutes has been used in various studies by clamping the catheter. Serious complications which can be encountered during the procedure include a small contracted bladder, urinary incontinence, VUR, ureteric strictures, vesico-ureteric junction obstruction with hydro-ureteronephrosis, acute tubular necrosis with anuria, vesico-vaginal fistula, vesico-ileal fistula, a toxic effect on myocardium, and rupture of the bladder (Godec et al, 1983). Deaths have been reported in extreme cases.…”