[Severe cyclophosphamide hemorrhagic cystitis controlled with transurethral electrocoagulation: a case report]

Area of Science:

• Urology
• Oncology
• Hematology

Background:

• Cyclophosphamide is an alkylating agent used in treating various autoimmune diseases and cancers.
• Evans syndrome is a rare autoimmune disorder characterized by the simultaneous presence of autoimmune hemolytic anemia and immune thrombocytopenia.

Observation:

• A 47-year-old woman with Evans syndrome developed massive hemorrhagic cystitis six months after completing a 2-year course of cyclophosphamide therapy.
• The onset of hemorrhagic cystitis was preceded by a common cold, suggesting a potential trigger for the delayed complication.

Findings:

• Embolization of bilateral internal iliac arteries was unsuccessful in controlling the severe bladder hemorrhage.
• Transurethral electrocoagulation of the bleeding bladder mucosa proved effective in significantly reducing bleeding and minimizing the need for further blood transfusions.

Implications:

• This case highlights the potential for delayed-onset cyclophosphamide-induced hemorrhagic cystitis, even long after treatment cessation.
• Transurethral electrocoagulation represents a viable and effective therapeutic option for managing severe, refractory hemorrhagic cystitis when less invasive methods fail.