INTRAVESICAL FORMALIN IN INTRACTABLE HEMATURIA

  • 1 January 1985
    • journal article
    • research article
    • Vol. 91  (1) , 33-35
Abstract
Eleven patients with bladder tumors classified T2 (2 cases), T3 (6 cases) or T4 (3 cases) .sbd. and 3 patients with radiation cystitis .sbd. were assessed as being beyond the scope of even palliative surgery, with severe hemorrhage being present in all cases. One patient was treated by total cystectomy and urinary diversion 21 mo. after intravesical formalin installation. Palliative hemostatic treatment was instituted in all cases by intravesical instillation of a 10% formalin solution under general anesthesia. Two patients received 3 and 5 instillations respectively, the former over 3 wk and the latter over 9 mo. The bladder was filled completely, and an indwelling catheter was introduced, the formalin solution being left in the bladder for 3-20 min (mean: 13 min). Hematuria was absent after 1-21 days (mean: 5.3 days) in 13 cases. The 14th patient died before arrest of hemorrhage. Survival after instillation was from 3 days to 32 mo. (mean 6.8 mo.). The outcome was fatal within 3 mo. or less in 8 cases, and 6 patients died within 2 mo. of acute renal failure, 1 within 3 days of instillation. In 5 cases, the treatment with formalin reduced bladder capacity to < 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 aggresive therapy.

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