Pharmaceutisch Weekblad

, Volume 11, Issue 5, pp 175–178 | Cite as

The use of an alum irrigation in the treatment of massive bladder haemorrhage

  • Rients Schootstra
  • Mels F. van Driel
  • Roy Hassankhan
  • Rika van de Werff
  • Evrard T. H. G. J. Oremus
  • Donald R. A. Uges
  • Han J. M. Mensink
Short Communications


Severe, massive bladder haemorrhage is a difficult and often frustrating clinical problem. The aetiologies are numerous and include irradiation, malignancy, severe infection and druginduced changes. Among the numerous modalities of treatment that have been reported formalin, phenol and silver nitrate instillations have often been associated with significant side effects, morbidity and mortality and have had varying degrees of success. During the last two years we have used continuous closed irrigation of a sterile 0.5% alum solution in 16 patients. Alum is an adstringent and acts by protein precipitation over the bleeding surface Because of a low cell permeability its action is limited to the cell surface and interstitial spaces. The permeability of the cell membrane is reduced but remains viable The preparation and the pharmaceutical aspects of the 0.5% alum irrigation will be discussed. The conclusion is that this technique of managing massive bladder haemorrhage is simple, efficient, nontoxic and less expensive than previously reported therapies. Therefore, irrigation with alum before instituting invasive means to control bleeding is recommended.


Alum Bladder Hemorrhage Irrigation 


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  1. 1.
    Brown RB. A method of management of inoperable carcinoma of the bladder. Med J Aust 1969;1:23.PubMedGoogle Scholar
  2. 2.
    Whittaker JR, Freed SZ. Effects of formalin on bladder urothelium. J Urol 1975;114:866–70.PubMedGoogle Scholar
  3. 3.
    Firlit CF. Intractable hemorrhage cystitis secondary to extensive carcinomatosis: management with formalin solution. J Urol 1973;110:57.PubMedGoogle Scholar
  4. 4.
    Barakat HA, Javadpour N, Bush IM. Management of massive intractable hematuria. A simple method. Urology 1973;1:351.PubMedGoogle Scholar
  5. 5.
    McGuire EJ, Weiss RM, Schiff M Jr, Lytton B. Hemorrhagic radiation cystitis: treatment. Urology 1974;3: 204.PubMedGoogle Scholar
  6. 6.
    Kalish M, Silber SJ, Herwig KR. Papillary necrosis. Result of intravesical instillation of formalin. Urology 1973;2:315.PubMedGoogle Scholar
  7. 7.
    Capen CV, Weigel JW, Magrina JF, Masterson BJ. Intraperitoneal spillage of formalin after intravesical instillation. Urology 1982;19:599.PubMedGoogle Scholar
  8. 8.
    Chugh KS, Singhal PC, Banerjee SS. Acute tubular necrosis following intravesical instillation of formalin. Urol Int 1977;32:454.PubMedGoogle Scholar
  9. 9.
    Laurie JA, Drysdale HC, Wynne EJ. Death following intravesical formalin instillation. Br J Urol 1977;49: 476.PubMedGoogle Scholar
  10. 10.
    Rao MS, Bagna BC, Chugh KS, et al. Fatal complication of intravesical formalin during control of intractable hemorrhage from radiation cystitis. Urology 1978;11: 588.PubMedGoogle Scholar
  11. 11.
    Scott MP Jr, Marshall S, Lyon RP. Bladder rupture following formalin therapy for hemorrhage secondary to cyclophosphamide therapy. Urology 1974;3:364.PubMedGoogle Scholar
  12. 12.
    Fishbein PG, McCurdy DK, DeFranzo RD, Murphy JJ. Irreversible bilateral ureteral obstruction from intravesical formaldehyde solution. JAMA 1974;288:872.Google Scholar
  13. 13.
    Susan LP, Marsh RJ. Phenolization of bladder in treatment of massive intractable hematuria. Urology 1975; 5:119.PubMedGoogle Scholar
  14. 14.
    Vermooten V, Peters PC, Johnson DE. Treatment of papillamatosis of the bladder with phenol and glycerin: a clinical and laboratory study. J Urol 1968;99:588.PubMedGoogle Scholar
  15. 15.
    Kumar APM, Wren EL Jr, Jayalakshmamma B, et al. Silver nitrate irrigation to control bladder hemorrhage in children receiving cancer therapy. J Urol 1976;116: 85–9.PubMedGoogle Scholar
  16. 16.
    Raghavaiah NV, Soloway MS. Anuria following silver nitrate irrigation for intractable bladder hemorrhage. J Urol1977;118:681–2.PubMedGoogle Scholar
  17. 17.
    Havey SC. Topical drugs. In: Osol A, ed. Remingtons pharmaceutical sciences. 16th ed. Easton: Mack Publishing Co., 1980:720.Google Scholar
  18. 18.
    Ostroff EB, Chenault QW Jr. Alum irrigation for the control of massive bladder hemorrhage. J Urol 1982;128: 929–30.PubMedGoogle Scholar
  19. 19.
    Mukamel E, Lupu A, De Kernion JB. Alum irrigation for severe bladder hemorrhage. J Urol 1986;135:784–5.PubMedGoogle Scholar
  20. 20.
    Goel AK, Rao MS, Bhagwat AG, et al. Intravesical irrigation with alum for the control of massive bladder hemorrhage. J Urol 1985;133:956–7.PubMedGoogle Scholar
  21. 21.
    Thompson IM, Teague JL, Mueller EJ, Rodriguez FR. Intravesical alum irrigation for intractable bleeding secondary to adenocarcinoma. J Urol 1987;137:525–6.PubMedGoogle Scholar
  22. 22.
    Kennedy C, Snell ME, Witherow RO. Use of alum to control intractable vesical haemorrhage. Br J Urol 1984; 56:673–5.PubMedGoogle Scholar
  23. 23.
    Haines ST. Alum irrigation for bladder hemorrhage. Drug Intell Clin Pharm 1986;20:671–2.Google Scholar
  24. 24.
    Kavoussi LR, Gelstein LD, Andriole GL. Encephalopathy and an elevated serum aluminium level in a patient receiving intravesical alum irrigation for severe urinary hemorrhage. J Urol 1986;136:665–7.PubMedGoogle Scholar
  25. 25.
    Helmstein P, Jacobsen K, Pederson JF, Sörensen JS. Intravesical hydrostatic pressure treatment: new method for control of bleeding from bladder mucosa. J Urol 1973;109:109–234.Google Scholar
  26. 26.
    Lapides J. Treatment of delayed intractable hemorrhagic cystitis following radiation or chemotherapy. J Urol 1970;104:707.PubMedGoogle Scholar
  27. 27.
    Sorenson JRJ, Campbell IR, Tepper LB, Lingg RD. Aluminum in the environment and human health. Environ Health Persp 1974;8:3.Google Scholar
  28. 28.
    Berlyne GM, Yagil R, Ben Ari J, et al. Aluminum toxicity in rats. Lancet 1972;1:564.PubMedGoogle Scholar

Copyright information

© Royal Dutch Association for Advancement of Pharmacy 1989

Authors and Affiliations

  • Rients Schootstra
    • 1
  • Mels F. van Driel
    • 2
  • Roy Hassankhan
    • 2
  • Rika van de Werff
    • 1
  • Evrard T. H. G. J. Oremus
    • 1
  • Donald R. A. Uges
    • 1
  • Han J. M. Mensink
    • 2
  1. 1.Department of PharmacyUniversity HospitalRB Groningenthe Netherlands
  2. 2.Department of UrologyUniversity HospitalGroningen

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