Abstract
Numerous modalities of treatment have been used in the past to control massive bladder haematuria, with varying degrees of success. Formalin has been used in urology only for the treatment of intractable haematuria of inoperable bladder carcinomas, usually as the last resort when all other nonsurgical attempts have failed and before more aggressive surgical measures are considered. Eight patients with bladder tumours classified T2 (2 cases), T3 (2 cases) or T4 (4 cases) and 2 patients with radiation cystitis were assessed as being beyond the scope of even palliative, surgery, severe haemorrhage being present in all cases. The treatment was instituted in all cases by intravesical instillation of a 10 per cent formalin solution under general anaesthesia. Four patients received 4 and 6 instillations, respectively, the former over 4 weeks and the latter over 10 months. The bladder was filled completely and an indwelling catheter introduced, the formalin solution being left in the bladder for 5 to 30 min (mean: 12 min). Haematuria was absent after 1 to 25 days (mean: 11 days) in 9 cases. The 10th patient died before arrest of haemorrhage. Survival after instillation was 65 days to 27 months (mean: 11.5 months). The outcome was fatal within 4 months or less in 3 cases and 4 patients died of renal failure within 3 months, one within 65 days after instillation. In 4 cases, treatment with formalin reduced bladder capacity to less than 100 ml. Other complications included retroperitoneal fibrosis (1 case), urinary incontinence (3 cases) and severe frequency and nocturia (3 cases). This procedure should therefore be reserved for terminal cases unable to support more aggressive therapy.
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References
Brown, R. B.: A method of management of inoperable carcinoma of the bladder.Med. J. Aust., 1, 23 (1969).
Berkson, B., Lome, L., Shapiro, I.: Cyclophosphamide (citoxan) cystitis: Management of severe hemorrhage. Annual Meeting of North Central Section American Urological Association, September 27–30, 1972.
Firlit, C. F.: Intractable hemorrhagic cystitis secondary to extensive carcinomatosis. Management with formalin solution.J. Urol., 110, 57 (1973).
McGurie, E. J., Weiss, R. M., Schiff, M. Jr., Lytton, B.: Haemorrhagic radiation cystitis: Treatment.Urology, 3, 204 (1974).
Fair, W. R.: Formalin in the treatment of massive bladder haemorrhage.Urology, 3, 573 (1974).
Haldt, T., Mygin, T.: Control of life-threatening vesical hemorrhage by unilateral hypogastric artery muscle embolization.J. Urol., 112, 60 (1974).
Holdstein, P., Jacobsen, K., Sovensen, J. S.: Intravesical hydrostatic pressure treatment: New method for control of bleeding from bladder mucosa.J. Urol., 109, 234 (1973).
Scott, M. P. Jr., Marshall, S., Lyon, R. P.: Bladder rupture following formalin therapy for hemorrhage secondary to cyclophosphamide therapy.,Urology, 3, 364 (1974).
Godec, C. J., Gleich, P.: Intractable hematuria and formalin.Urology, 130, 688 (1983).
Finkelstein, L. H., Arsht D. B., Trenkle, D.: Vesico-ileal fistula: An unusual complication following the use of formalin for control of refractory post-irradiation bladder hemorrhage.J. Urol., 117, 168 (1977).
Whittaker, J. R., Freed, S. Z.: Effects of formalin on bladder urothelium.J. Urol., 114, 866 (1975).
Kumar, S.: Effect of intravesical formalin on the urothelium.Br. J. Urol., 51, 375 (1979).
Spiro, L. H., Mecht, M., Morowitz, A., Orkin, L.: Formalin treatment for massive bladder hemorrhage.Urology, 2, 669 (1973).
Rankin, K. N.: Intravesical formalin.Invest. urol., 12, 150 (1974).
Servadio, C., Nissenkorn, I.: Massive hematuria successfully treated by bladder irrigations with formalin instillation.Cancer, 37, 900 (1976).
Chugh, K. S., Singhal, P. C., Banerjee, S. S.: Acute tubular necrosis following intravesical instillation of formalin.Urol. Int., 32, 454 (1977).
Gaston de Iriarte, E., Mertinez-Pineiro, J. A., de la Pena, J., Torronteral, J. M., Hidalgo, L.: La hemorrhagia vesical incoercible: Glutaraldehizacion. Nueva alternativa terapeutica?Actas Urol. Esp., 6, 353 (1981).
Fishbein, P. G., McCurdy, D. K., Defronzo, R. D., Murphy, J. J.: Irreversible bilateral ureteral obstruction from intravesical formaldehyde solution.J.A.M.A., 228, 872 (1974).
Kumar, S., Rosen, P., Grabstald, H.: Intravesical formalin for the control of intractable bladder haemorrhage secondary to cystitis of cancer.J. Urol., 114, 540 (1975).
Lourie, J. A., Drysdale, H. C., Wynne, E. J.: Death following intravesical formalin instillation.Br. J. Urol., 49, 476 (1977).
Capen, C. V., Weigel, J. W., Magrina, J. F., Masterson, B. J.: Intraperitoneal spillage of formalin after intravesical instillation.Urology, 19, 599 (1982).
Ferrie, B. G., Smith, P. J. B., Kirk, D.: Retroperitoneal fibrosis complicating intravesical formalin therapy.J. Roy. Soc. Med., 76, 831 (1983).
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Giannakopoulos, X., Grammeniatis, E., Chambilomatis, P. et al. Massive haemorrhage of inoperable bladder carcinomas: Treatment by intravesical formalin solution. International Urology and Nephrology 29, 33–38 (1997). https://doi.org/10.1007/BF02551414
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DOI: https://doi.org/10.1007/BF02551414