The management of haemorrhagic cystitis with sodium pentosan polysulphate

Abstract

OBJECTIVE To assess the use of sodium pentosan polysulphate (SPP) for haemorrhagic cystitis (HC), a potentially life‐threatening side‐effect in patients treated with pelvic radiotherapy or cyclophosphamide, and which can be difficult to manage as patients often have significant comorbidity. PATIENTS AND METHODS Between September 1991 and December 2000, 60 consecutive patients (24 women and 36 men) with haemorrhagic cystitis were primarily treated with SPP; 53 patients had had radical radiotherapy for pelvic malignancy and seven systemic cyclophosphamide. All patients were screened for blood dyscrasia and residual/primary urothelial malignancy with imaging, urine cytology and cystoscopy. RESULTS In all, 51 patients were available for follow‐up; the median (range) interval between completing treatment and developing haematuria was 4.5 (0.08–39.4) years, the duration of treatment 180 (21–1745) days and patients were followed for 450 (19–4526) days from the onset of haematuria. All patients were started on SPP at an initial dose of 100 mg three times daily. In 21 patients the dose was gradually reduced to a maintenance dose of 100 mg and in 10 further patients SPP was stopped because the haematuria stopped completely. Twenty patients died while on treatment from causes not directly related to their haematuria. CONCLUSION We recommend the use of SPP as the primary method of managing haemorrhagic cystitis associated with pelvic radiotherapy or systemic chemotherapy.

Prevention and management of BK‐virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation – a systematic review and evidence‐based guidance for clinical management

“…(Kadrnka, 1981;Marberger et al, 1981;Sanchiz et al, 1996) Sodium pentosan polysulphate Interstitial cystitis, radiation cystitis (Parsons, 1986;Hampson & Woodhouse, 1994;Hwang et al, 1997;Sandhu et al, 2004) Berberine Animal study (Xu & Malave, 2001) N-acetylcysteine Animal study (Palma et al, 1986) Treatment Epsilon-aminocaproic acid Haemorrhage after prostrate resection, cystitis after radiation/chemotherapy (Sharifi et al, 1986;Singh & Laungani, 1992) Sairei-to Radiation/non-radiation cystitis (Shida et al, 1994) Orgotein Radiation cystitis (Kadrnka, 1981;Marberger et al, 1981;Sanchiz et al, 1996) Sodium pentosan polysulphate Interstitial cystitis, radiation cystitis (Parsons, 1986;Hampson & Woodhouse, 1994;Hwang et al, 1997;Sandhu et al, 2004) Nystatin…”

Management of radiation cystitis

“…Hampson and Woodhouse 25 reported that 9 of 14 patients with hemorrhagic radiation cystitis achieved control of hematuria after treatment with oral sodium pentosan polysulfate. Sandhu et al 26 also recommended the use of oral sodium pentosan polysulfate as the primary method of managing hemorrhagic cystitis associated with pelvic radiation therapy, based on their experience with 51 patients, of whom 31 responded (21 had their dose reduced to a maintenance dose and 10 stopped treatment). The results were durable after a median follow-up of 450 days (range 19-4,526 days).…”

Introduction of sodium pentosan polysulfate and avoidance of urethral catheterisation: improved outcomes in children with haemorrhagic cystitis post stem cell transplant/chemotherapy

“…Sandhu et al [9] highlighted the potential that SPP has in the management of HC in adult patients. We hypothesised that its effects could be beneficial in paediatric cases of HC.…”

“…Its use has dramatically improved outcomes in adults who developed HC secondary to pelvic radiotherapy and cyclophosphamide [9].…”