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

Vicente, J.; Ríos, Gloria; Caffaratti, Jorge

doi:10.1159/000463910

Cited by 42 publications

(19 citation statements)

References 20 publications

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“…The seven hemorrhagic recurrences were controlled by one instillation. Similar results have been published by Vicente et al [46] on 25 radiation or cyclophosphamide HC cases. Eighty-eight percent of responses lasted an average delay of 4 months.…”

Section: Formalinsupporting

confidence: 91%

A Practical Approach to the Management of Radiation-Induced Hemorrhagic Cystitis

Liem

Saad

Delouya

2015

Drugs

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Radiation-induced hemorrhagic cystitis (HC) is a complication of pelvic radiotherapy, mainly for prostate and uterine cancers. In the acute phase, patients feel urinary urgency and bladder pain. This phase is reversible after radiotherapy. In the chronic stage, an irritative syndrome is coupled with hematuria during the 2-10 years following radiotherapy. Cystoscopy shows white and frosted mucosa with telangiectasia. The incidence is estimated at 5 % or less. It is suggested that the radiation oncologist reviews the dosimetry plan to validate that the lesions coincide with significant radiation exposure confirming diagnosis of radiation-induced HC. The treatment for HC is first symptomatic, with bladder lavage, clot evacuation, coagulation via cystoscopy and blood transfusions if necessary. Subsequently, hyaluronic acid bladder instillation can be done with little toxicity. Hyperbaric oxygen therapy delivers pure oxygen to patients in a pressurized cabin, promoting angio-neogenesis and lowering hypoxia to the irradiated tissues. The clinical response rate is estimated to be around 80 %. Nevertheless, this approach is limited by the low availability, and length of treatment. While surgery remains an effective treatment for HC, it is the last option because of the high morbidity and mortality risks. Prospective studies need to be conducted to identify and evaluate new interventions, particularly for HC.

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Section: Formalinsupporting

confidence: 91%

A Practical Approach to the Management of Radiation-Induced Hemorrhagic Cystitis

Liem

Saad

Delouya

2015

Drugs

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“…19,20,21,22,23,24 Intravesical formalin instillation is performed under general or regional anesthesia once vesicoureteral reflux has been excluded. It causes precipitation of cellular proteins in the mucosa, producing an occlusive and fixative action on telangiectatic tissue and small capillaries.…”

Section: Formalinmentioning

confidence: 99%

Management of radiation cystitis

2010

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Acute radiation cystitis occurs during or soon after radiation treatment. It is usually self-limiting, and is generally managed conservatively. Late radiation cystitis, on the other hand, can develop from 6 months to 20 years after radiation therapy. The main presenting symptom is hematuria, which may vary from mild to severe, life-threatening hemorrhage. Initial management includes intravenous fluid replacement, blood transfusion if indicated and transurethral catheterization with bladder washout and irrigation. Oral or parenteral agents that can be used to control hematuria include conjugated estrogens, pentosan polysulfate or WF10. Cystoscopy with laser fulguration or electrocoagulation of bleeding points is sometimes effective. Injection of botulinum toxin A in the bladder wall may relieve irritative bladder symptoms. Intravesical instillation of aluminum, placental extract, prostaglandins or formalin can also be effective. More-aggressive treatment options include selective embolization or ligation of the internal iliac arteries. Surgical options include urinary diversion by percutaneous nephrostomy or intestinal conduit, with or without cystectomy. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at higher than atmospheric pressure. The reported success rate of HBOT for radiation cystitis varies from 60% to 92%. An important multicenter, doubleblind, randomized, sham-controlled trial to evaluate the effectiveness of HBOT for refractory radiation cystitis is currently being conducted.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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. 18 In contrast, we report that one of the eight patients (13%) underwent simple cystectomy secondary to …”

Section: Discussionmentioning

confidence: 99%

Intravesical formalin for hemorrhagic cystitis: A contemporary cohort

Ziegelmann

Boorjian

Joyce

et al. 2017

CUAJ

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Introduction: Hemorrhagic cystitis presents a difficult clinical challenge, yet data regarding treatment options is sparse. Here, we sought to evaluate outcomes of a contemporary cohort of patients treated with intravesical formalin for hemorrhagic cystitis.Methods: We identified a retrospective cohort of eight patients managed with formalin for hemorrhagic cystitis from 2000‒2014. All patients failed prior measures, including bladder irrigation, clot evacuation, and other intravesical agents. Treatment success was defined as hematuria resolution during the given hospitalization without use of additional invasive therapies. We also evaluated treatment complications and additional treatments following hospital dismissal.Results: Etiology of cystitis was radiation for malignancy in all cases. The formalin concentration ranged from 1‒4%, with escalation used in treatment failures. Five patients (62.5%) received a single dose of 1% formalin, two patients received two doses, and one patient received three doses. Notably, intraoperative cystography identified vesicoureteral reflux (VUR) in 50.0% of patients. Six patients (75.0%) achieved treatment success, with a median time to resolution of four days (range 1‒17 days). Of those refractory to formalin, one was managed with indwelling nephrostomy tubes and one underwent cystectomy. Median followup was eight months. Of the responders, two eventually required cystectomy, one for recurrent hematuria and one for recalcitrant bladder neck contracture and bladder dysfunction. The remaining four patients (50%) required no additional therapy.Conclusions: Formalin remains an important tool for treating refractory hemorrhagic cystitis, with roughly 75.0% of patients requiring no additional therapy prior to hospital discharge. Notably, there is a risk of bladder dysfunction following formalin.

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

Cited by 42 publications

References 20 publications

A Practical Approach to the Management of Radiation-Induced Hemorrhagic Cystitis

A Practical Approach to the Management of Radiation-Induced Hemorrhagic Cystitis

Management of radiation cystitis

Intravesical formalin for hemorrhagic cystitis: A contemporary cohort

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