Intravesical formalin in intractable haematuria

Eleven patients with bladder tumours classified T2 (2 cases), T3 (6 cases) or T4 (3 cases) - and 3 patients with radiation cystitis - were assessed as being beyond the scope of even palliative surgery, severe haemorrhage being present in all cases. One patient was treated by total cystectomy and urinary diversion 21 months after intravesical formalin installation. Palliative haemostatic treatment was instituted in all cases by intravesical instillation of a 10% formalin solution under general anaesthesia. Two patients received 3 and 5 instillations respectively, the former over 3 weeks and the latter over 9 months. The bladder was filled completely and an indwelling catheter introduced, the formalin solution being left in the bladder for from 3 to 20 minutes (mean: 13 minutes). Haematuria was absent after from one to 21 days (mean: 5.3 days) in 13 cases. The 14th patient died before arrest of haemorrhage. Survival after instillation was from 3 days to 32 months (mean 6.8 months). The outcome was fatal within 3 months or less in 8 cases and 6 patients died within 2 months of acute renal failure, one within 3 days of instillation. In 5 cases the treatment with formalin reduced bladder capacity to less than 100 ml. Other complications included acute infection of thigh, ruptured bladder, retroperitoneal fibrosis and severe frequency and nocturia (1 case each), and this procedure should therefore be reserved for terminal cases unable to support more aggressive therapy.