Hemorrhagic Cystitis

Hemorrhagic cystitis - Main causes

• Banal bacterial cystitis
• Chemotherapy: cyclophosphamide, ifosfamide (via a catabolite, acrolein), occurring early after the administration of cytostatic (1 to 3 days)
• Bone marrow transplants: BK polyomavirus, adenovirus, occurring late after transplantation (25 days on average, between one and 18 weeks in the interval)
• Radiotherapy
• Beware of the facilitators of coagulation disorders (thrombocytopenia) and bladder cancer unknown underlying

Hemorrhagic cystitis - Clinical picture

• Haematuria
• Caillottage bladder with urinary retention
• Pain: cystalgies
• Haemorrhagic shock

Prevention (in case of treatment with cyclophosphamide or ifosfamide): several methods:

• Aggressive hyperhydratation : obtain a diuresis of at least 200 ml / h
• Bladder irrigation: at a rate of 1 l of 0.9% NaCl per hour , until 24 h after treatment
• Uromitexanr(mesna): 100 to 160% of the dose of cyclophosphamide or ifosfamide dividing every 3 to 4 hours or 3 x 4 or by bolus (20 to 40% DT) and then continuous infusion 24 h

Hemorrhagic cystitis Treatment

• Correct any clotting disorders
• Bladder washing
• Forced diuresis
• Pickup mesna
• By cytoscopique cautery, coagulation by instillation of formalin
• As a last resort: consider cystectomy