Experimental Cytoxan Cystitis and Prevention by Acetylcysteine

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Abstract
Cytoxan (cyclophosphamide) given to rats i.p. produced a severe cystitis within 4 h with marked inflammatory edema and hemorrhagic ulcerations of the mucosa. An in vivo staining test wth methylene blue showed deep staining of the urothelium as was demonstrated with other types of urothelial injuries; uninjured urothelium does not stain. The cytoxan cystitis is probably not due to cytoxan itself, but to a breakdown product acrolein, an aldehyde appearing in the urine. Rat experiments demonstrated that acrolein instilled intravesically produced a cystitis similar to that found with cytoxan injected intraperitoneally. The cystitis due either to cytoxan or acrolein was prevented by simultaneous intravesical administration of an aldehyde inactivating agent, acetylcysteine (mucomyst).