The Helmstein bladder distension treatment for tumours and severe bleeding

Abstract

The Helmstein bladder distension treatment was applied to 26 patients, who received a total of 70 treatments (52 for bladder tumour and 18 for severe bleeding; in 7 cases for both tumour and bleeding). In the T2 tumours total necrosis occurred in 27% of the cases, partial necrosis in 50% and no necrosis in 23%. Of the patients with total necrosis 64% had recurrences within 12 months. In the T3-T4 tumours only 33% had a temporary slight reduction of the tumour mass. In patients with severe bleeding from the bladder, haematuria ceased within 1 to 5 days after the treatment in 12 out of 18 cases. Bleeding, however, recurred after an average of 3 months. It is concluded that the treatment is useful in selected cases with multiple tumours of the bladder, and the method is effective in controlling severe bleeding from the bladder.

Therapeutic options for intractable hematuria in advanced bladder cancer

“…Over a decade later, in 1986, Antonsen et al . studied the effect of hydrostatic bladder distention on both hematuria and tumor necrosis in 18 patients with severe bleeding . A total of 12 patients showed cessation of hematuria within 1–5 days after treatment, with a recurrence of bleeding after a mean of 3 months.…”

“…Bladder rupture was only a very rare complication when pressure was limited to 10–25 cm H 2 O above diastolic blood pressure. Abdominal pain, nausea, temporary incontinence and pyrexia were reported more commonly …”

The management of intractable haematuria

“…Helmstein's original treatment involved giving a high epidural anaesthetic to achieve total atony of the bladder (in only one study [10] was general anaesthesia used and the authors claimed a decreased risk of bladder rupture). The intravesical pressure was increased by either simply filling the bladder with normal saline via a Foley catheter, or by using a balloon attached to a cut Foley catheter through which a steel tube was advanced (both condoms [11], party balloons [12] and specially designed balloons [13] have been used).…”

“…The most common serious side‐effect of hydrodistension was rupture of the bladder, which could be either partial or total. In his first 13 treatments, Helmstein described two total ruptures and one perforation through an ulcerated tumour; others have reported ruptured bladder [10,16]. The occurrence of perforation could be predicted by a sudden increase in the drip‐rate of the infused normal saline.…”

“…Deaths after the procedure have been reported but not directly attributed to the treatment. An elderly patient in heart failure had an extension of a recent myocardial infarction [16] and another two patients died from pulmonary embolism within 3 days of the procedure [10]. The most common minor complications included nausea and vomiting, temporary incontinence [12], severe abdominal pain that settled spontaneously [14] and pyrexia [10,12,14].…”