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

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 in...

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Autores principales: Westerman, Mary E., Boorjian, Stephen A., Linder, Brian J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Urologia 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117970/
https://www.ncbi.nlm.nih.gov/pubmed/27509371
http://dx.doi.org/10.1590/S1677-5538.IBJU.2015.0588
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author Westerman, Mary E.
Boorjian, Stephen A.
Linder, Brian J.
author_facet Westerman, Mary E.
Boorjian, Stephen A.
Linder, Brian J.
author_sort Westerman, Mary E.
collection PubMed
description 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 pubmed-51179702016-11-22 Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: a contemporary evaluation Westerman, Mary E. Boorjian, Stephen A. Linder, Brian J. Int Braz J Urol Original Article 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 Urologia 2016 /pmc/articles/PMC5117970/ /pubmed/27509371 http://dx.doi.org/10.1590/S1677-5538.IBJU.2015.0588 Text en http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Westerman, Mary E.
Boorjian, Stephen A.
Linder, Brian J.
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
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_short 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
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117970/
https://www.ncbi.nlm.nih.gov/pubmed/27509371
http://dx.doi.org/10.1590/S1677-5538.IBJU.2015.0588
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