Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation

Detalhes bibliográficos
Autor(a) principal: Westerman,Mary E.
Data de Publicação: 2016
Outros Autores: Boorjian,Stephen A., Linder,Brian J.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: International Braz J Urol (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382016000601144
Resumo: ABSTRACT Introduction: Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regarding safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort. Materials and Methods: We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation. Results: Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95%). Alum use decreased patient's transfusion requirement, with 82% (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59% (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60%) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5%) remained without additional treatment for HC. Adverse effects were reported in 15 patients (38%), with bladder spasms representing the most common event (14/40; 35%). No clinical evidence of clinically significant systemic absorption was detected. Conclusion: Intravesical alum therapy is well-tolerated, with resolution of HC in approximately 60% of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.
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spelling Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluationCystitisHematuriaUrinary BladderRadiotherapyABSTRACT Introduction: Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regarding safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort. Materials and Methods: We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation. Results: Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95%). Alum use decreased patient's transfusion requirement, with 82% (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59% (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60%) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5%) remained without additional treatment for HC. Adverse effects were reported in 15 patients (38%), with bladder spasms representing the most common event (14/40; 35%). No clinical evidence of clinically significant systemic absorption was detected. Conclusion: Intravesical alum therapy is well-tolerated, with resolution of HC in approximately 60% of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.Sociedade Brasileira de Urologia2016-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382016000601144International braz j urol v.42 n.6 2016reponame:International Braz J Urol (Online)instname:Sociedade Brasileira de Urologia (SBU)instacron:SBU10.1590/s1677-5538.ibju.2015.0588info:eu-repo/semantics/openAccessWesterman,Mary E.Boorjian,Stephen A.Linder,Brian J.eng2016-11-22T00:00:00Zoai:scielo:S1677-55382016000601144Revistahttp://www.brazjurol.com.br/ONGhttps://old.scielo.br/oai/scielo-oai.php||brazjurol@brazjurol.com.br1677-61191677-5538opendoar:2016-11-22T00:00International Braz J Urol (Online) - Sociedade Brasileira de Urologia (SBU)false
dc.title.none.fl_str_mv Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation
title Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation
spellingShingle Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation
Westerman,Mary E.
Cystitis
Hematuria
Urinary Bladder
Radiotherapy
title_short Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation
title_full Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation
title_fullStr Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation
title_full_unstemmed Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation
title_sort Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation
author Westerman,Mary E.
author_facet Westerman,Mary E.
Boorjian,Stephen A.
Linder,Brian J.
author_role author
author2 Boorjian,Stephen A.
Linder,Brian J.
author2_role author
author
dc.contributor.author.fl_str_mv Westerman,Mary E.
Boorjian,Stephen A.
Linder,Brian J.
dc.subject.por.fl_str_mv Cystitis
Hematuria
Urinary Bladder
Radiotherapy
topic Cystitis
Hematuria
Urinary Bladder
Radiotherapy
description ABSTRACT Introduction: Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regarding safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort. Materials and Methods: We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation. Results: Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95%). Alum use decreased patient's transfusion requirement, with 82% (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59% (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60%) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5%) remained without additional treatment for HC. Adverse effects were reported in 15 patients (38%), with bladder spasms representing the most common event (14/40; 35%). No clinical evidence of clinically significant systemic absorption was detected. Conclusion: Intravesical alum therapy is well-tolerated, with resolution of HC in approximately 60% of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.
publishDate 2016
dc.date.none.fl_str_mv 2016-12-01
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382016000601144
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dc.language.iso.fl_str_mv eng
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dc.relation.none.fl_str_mv 10.1590/s1677-5538.ibju.2015.0588
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dc.publisher.none.fl_str_mv Sociedade Brasileira de Urologia
publisher.none.fl_str_mv Sociedade Brasileira de Urologia
dc.source.none.fl_str_mv International braz j urol v.42 n.6 2016
reponame:International Braz J Urol (Online)
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collection International Braz J Urol (Online)
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