Treatment of Radiation or Cyclophosphamide Induced Hemorrhagic Cystitis using Conjugated Estrogen

Abstract

Five patients with severe hemorrhagic cystitis induced by radiation and/or cyclophosphamide were systematically treated with conjugated estrogen. Two patients received conjugated estrogen twice each day (1 mg. per kg.) intravenously, followed on day 3 and thereafter by 5 mg. per day orally. Hematuria decreased markedly 6 to 8 hours after the initial dose and urine color became light yellow within 1 to 3 days. The other 3 patients received 5 mg. conjugated estrogen per day orally and urine color became clear within 4 to 7 days. Hematuria did not recur during 12 to 22 months in 4 patients who received daily conjugated estrogen (1.25 mg.). However, transient episodes of mild hematuria persisted in 1 patient during the 3-month followup despite a higher dose of conjugated estrogen (10 mg. per day). Complications, including thromboembolism and other side effects associated with conjugated estrogen, were not observed in these patients. We postulate that conjugated estrogen controls hematuria in hemorrhagic cystitis by decreasing the fragility of the mucosal microvasculature of the bladder.

Estrogen as treatment of hemorrhagic cystitis in children and adolescents undergoing bone marrow transplantation

“…Other noninvasive measures have included hyperbaric oxygen, prostaglandins 6 and estrogens. 2,[7][8][9] Where blood clots are being passed or where urinary tract obstruction is suspected, bladder washouts may also be required. Endoscope examination of the bladder lining with cauterization of bleeding mucosa may also be of benefit.…”

Encouraging results in the treatment of haemorrhagic cystitis with estrogen – report of 10 cases and review of the literature

“…In 1990, Liu and colleagues 18 reported five responding patients. Two patients were treated with intravenous estrogen twice daily (1 mg/kg).…”

“…Case reports about oral estrogen as an effective treatment of HC have prompted us to try this modality in affected patients. [17][18][19] …”

Management of radiation cystitis

“…Liu et al 27 used conjugated estrogen in five patients unresponsive to other treatment options. Two patients received conjugated estrogen intravenously (1 mg/kg twice daily) for 2 days, and orally (5 mg once daily) thereafter.…”