Intravesical formalin in intractable haematuria

Area of Science:

• Urology
• Oncology
• Nephrology

Background:

• Patients with advanced bladder tumors (T2-T4) or radiation cystitis often present with severe, intractable hemorrhage.
• Palliative surgical options are frequently not feasible for these patients.
• Effective hemostatic management is crucial for improving quality of life in terminal cases.

Purpose of the Study:

• To evaluate the efficacy and safety of intravesical formalin instillation as a palliative hemostatic treatment for severe bladder hemorrhage.
• To assess outcomes and complications associated with this therapeutic approach.

Main Methods:

• Intravesical instillation of 10% formalin solution under general anesthesia in 14 patients with severe bladder hemorrhage.
• Formalin was retained in the bladder for a mean of 13 minutes.
• Treatment involved 1-5 instillations over varying periods.

Main Results:

• Hematuria cessation was achieved in 13 of 14 patients within a mean of 5.3 days.
• Survival ranged from 3 days to 32 months (mean 6.8 months).
• Significant complications included reduced bladder capacity (<100 ml) in 5 cases, and a high mortality rate (8/14 within 3 months), with 6 deaths due to acute renal failure.

Conclusions:

• Intravesical formalin instillation can be an effective hemostatic agent for severe bladder hemorrhage in patients with advanced disease.
• The procedure is associated with substantial morbidity and mortality and should be reserved for terminal cases.
• Careful patient selection and consideration of potential complications are essential.