Intractable Hematuria Research Articles

Aluminum Toxicity and Death Following Intravesical Alum Irrigation in a Patient with Renal Impairment

Intravesical alum irrigation is the safest and most effective method of treatment for intractable hematuria. Systemic absorption is reported to be minimal and there have been no reported deaths following its use. We describe an elderly man with compromised renal function (serum creatinine 420 μmol./l.) who was treated with 1% alum irrigation for 48hours for hematuria due to inoperable bladder cancer. He received a total of 9.6 1. during 48hours, which controlled the bleeding. After cessation of the alum he became lethargic, suffered respiratory depression and died the next day. Laboratory data showed mild metabolic acidosis and increasing daily aluminum levels that peaked at 7,014nmol./l. (toxic greater than 2,000) beginning on the day after treatment was commenced. The efficacy and safety profile of alum irrigation is discussed.

Cystotomy, Temporary Urinary Diversion And Bladder Packing in the Management of Severe Cyclophosphamide-Induced Hemorrhagic Cystitis

Severe hemorrhage from cyclophosphamide-induced cystitis sometimes requires aggressive open management when conventional endoscopic and intravesical therapies have failed. We present 2 patients with intractable hematuria who were managed by open cystotomy, temporary urinary diversion via external ureteral stents, and continuous postoperative bladder packing with gauze and hemostatic agents. Both patients had a dramatic improvement in the hematuria immediately postoperatively and 1 with prolonged followup has no urological disability. We suggest that this procedure be considered for management of severe hemorrhagic cystitis as an alternative to more aggressive surgical therapies, such as formal urinary diversion with cystectomy. (J. Urol., 143:1006-1007, 1990)

Intravesical Alum Irrigation for Intractable Bleeding Secondary to Adenocarcinoma of the Prostate

We report on 2 patients in whom intractable hematuria was caused by carcinoma of the prostate. Since the hematuria failed to respond to conservative measures, intravesical 1 per cent alum irrigation was used. Hematuria resolved in both patients and no toxicity was observed. Intravesical alum irrigation should be considered in any patient with significant hematuria secondary to carcinoma of the prostate in whom conservative therapy has failed.

Renal and urinary tract complications following the intravesical instillation of formalin

The case is reported of a 10-yr-old girl who developed intractable hematuria from hemorrhagic cystitis following chemotherapy for a malignant lymphoma. Following the intravesical instillation of formalin, which controlled the hematuria, she developed oliguria attributable to ureteric stenosis and fibrotic contraction of the renal pelves. Bilateral nephrostomies were constructed, but recurrent pyelonephritis and further renal pelvic obstruction developed. A series of renal biopsies and ultimately bilateral nephrectomy revealed severe, chronic interstitial nephritis, massive renal interstitial accumulation of deposits probably containing Tamm-Horsfall protein and, in the left nephrectomy specimen, a florid interstitial chronic granulomatous inflammatory reaction. Although ureterohydronephrosis has been described by others as a complication of the intravesical instillation of formalin, fibrotic contraction of the upper urinary tract and the florid interstitial nephritis with granulomata as described herein have not previously been reported. It is proposed that vesicoureteric reflux of formalin, perhaps accompanied by intrarenal reflux, caused or contributed to these pathological changes.

Massive intractable hematuria secondary to cyclophosphamide

A case of massive intractable hematuria following cyclophosphamide therapy is presented. This patient had bilateral vesicoureteral reflux. The treatment consisted of occluding both ureters with Fogarty catheters while formalin was instilled into the bladder. The urine has cleared with no further gross hematuria. This has been accomplished in another patient with unilateral vesicoureteral reflux with equal success.

膀胱腫瘍に対する温水療法の研究 (第2報)

Preliminary clinical studies suggested that hyperthermic treatment resulted in regression of bladder tumor. The present paper is aimed to discuss the efficacy of this method by analysing 69 cases of bladder tumors. The bladder was treated with heated irrigant 10 times continuously unless side effect occurred. Thio-Tepa or Adriamycin was added to the irrigant in some cases.1) Complete and partial regressions were noted in 15 of the 69 cases and 28 of the 69 cases respectively, while no regression was observed in 26 of the 69 cases. Therefore, 63 per cent (43 of 69 cases) showed tumor regression by the hyperthermic treatment. In relation to the clinicopathological study and hyperthermia, regression was noted in 82 per cent of pedunculated tumors, 92per cent of small tumors, 80per cent of TI tumors, and 77per cent of grade I tumors.2) 18 cases with severe complication were treated with hyperthermia. Regression was seen in 56 per cent (10 of 18). 3 died of tumor and 2 died of cardiovascular diseases. 5 were alive over one year.3) Intractable hematuria was terminated or controlled in 50per cent (8 of 16) and macroscopic hematuria was terminated in 70per cent (19 of 27) following hyperthermia.4) As the side effect, pronounced high blood pressure was recorded in 37 cases during the treatment. Following hyperthermia, acute epididymitis was found in 7 cases. 11 developed vesicoureteral reflux after the treatment.5) Of 54 cases with complete follow up data, recurrence of the tumors was noted in 12 cases (22per cent). Recurrence occurred within 6 months in 5 cases, within one year in 6 cases and after one year in 1 case. These results may not indicate that hyperthermia is of value in the prevention of tumor recurrence.Therefore, hyperthermic treatment is effective for superficial bladder tumor, and may be applied to patients with severe complications.

Foreign body in lower urinary tract.

A forty-four-year-old white man had a stout rubber cable extruding 2 cm. from the external urethral meatus. He had introduced an 82-cm. rubber cable via his urethra into his bladder to assist in clearing dysuria and hematuria. Suprapublic removal of the rubber cable was accomplished, and his postoperative course was benign.

Intravesical instillation of formalin for the management of intractable hematuria.

Intravesical instillation of formalin for the management of intractable hematuria.