Hemorrhagic Cystitis Guidelines

Updated: Dec 15, 2020
  • Author: Joseph Basler, MD, PhD; Chief Editor: Edward David Kim, MD, FACS  more...
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Guidelines Summary

The Canadian Urological Association (CUA) has released a best practice report on the diagnosis and management of radiation-induced hemorrhagic cystitis (RHC).  Key recommendations include [172] :

  • Initial cystoscopy with or without fulguration of suspect lesions for post-radiation patients with hematuria
  • Aluminous salts irrigation has a comparatively acute onset of action that is generally well-tolerated. Aluminum toxicity has been reported in individuals in renal failure and caution should be used in patients with poor renal function. 
  • Intravesical therapy with hyaluronic acid (HA) may improve symptoms of RHC. Slow onset of action and lack of evidence in severe hematuria limit its usefulness.
  • Hyperbaric oxygen therapy (HBOT)​ should be considered when cystoscopy and fulguration have failed. 
  • Selective and super-selective transarterial embolizations (TAE) is a second-line treatment option when less invasive treatments have failed.
  • Formalin instillations should be used only when less invasive treatments have failed. All attempts should be made to prevent reflux into the upper tracts, and careful monitoring for potential adverse effects is required.
  • Urinary diversion with or without cystectomy should be reserved for patients in whom previously available therapy has failed, and who are aware of the high morbidity and mortality of the procedure.