[Hemorrhagic cystitis after high dose chemotherapy. An interdisciplinary problem]

Hemorrhagic cystitis is a well known toxic and often life-threatening complication from high-dose chemotherapy with cyclophosphamide. The incidence is particularly high after allogeneic bone marrow transplantation. The morphologic bladder wall changes are associated with gross hematuria, clot formation in the bladder and problems to control the bleeding in up to 70% without preventive measures. Prevention is routinely done and can reduce but not obviate the incidence of hemorrhagic cystitis. Treatment is initiated by forced diuresis and continuous bladder irrigation. When necessary endoscopic cauterisation of bleeding mucosal areas is combined with the instillation of hemostyptic agents. Embolisation of the pelvic vessels or open surgery to control the bleeding is indicated in selected cases in a life-threatening situation.