Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis

A contemporary evaluation

Mary E. Westerman, Stephen A. Boorjian, Brian J. Linder

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regarding safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort. Materials and Methods: We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation. Results: Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95%). Alum use decreased patient's transfusion requirement, with 82% (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59% (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60%) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5%) remained without additional treatment for HC. Adverse effects were reported in 15 patients (38%), with bladder spasms representing the most common event (14/40; 35%). No clinical evidence of clinically significant systemic absorption was detected. Conclusion: Intravesical alum therapy is well-tolerated, with resolution of HC in approximately 60% of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.

Original languageEnglish (US)
Pages (from-to)1144-1149
Number of pages6
JournalInternational Braz J Urol
Volume42
Issue number6
DOIs
StatePublished - 2016

Fingerprint

Cystitis
Safety
Urinary Bladder
Therapeutics
Intravesical Administration
aluminum sulfate
Spasm
Radiation

Keywords

  • Cystitis
  • Hematuria
  • Radiotherapy
  • Urinary Bladder

ASJC Scopus subject areas

  • Urology

Cite this

Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis : A contemporary evaluation. / Westerman, Mary E.; Boorjian, Stephen A.; Linder, Brian J.

In: International Braz J Urol, Vol. 42, No. 6, 2016, p. 1144-1149.

Research output: Contribution to journalArticle

Westerman, Mary E. ; Boorjian, Stephen A. ; Linder, Brian J. / Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis : A contemporary evaluation. In: International Braz J Urol. 2016 ; Vol. 42, No. 6. pp. 1144-1149.
@article{716e27cfb63d47d0b7536fe56db4a39e,
title = "Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: A contemporary evaluation",
abstract = "Introduction: Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regarding safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort. Materials and Methods: We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation. Results: Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95{\%}). Alum use decreased patient's transfusion requirement, with 82{\%} (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59{\%} (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60{\%}) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5{\%}) remained without additional treatment for HC. Adverse effects were reported in 15 patients (38{\%}), with bladder spasms representing the most common event (14/40; 35{\%}). No clinical evidence of clinically significant systemic absorption was detected. Conclusion: Intravesical alum therapy is well-tolerated, with resolution of HC in approximately 60{\%} of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.",
keywords = "Cystitis, Hematuria, Radiotherapy, Urinary Bladder",
author = "Westerman, {Mary E.} and Boorjian, {Stephen A.} and Linder, {Brian J.}",
year = "2016",
doi = "10.1590/S1677-5538.IBJU.2015.0588",
language = "English (US)",
volume = "42",
pages = "1144--1149",
journal = "International braz j urol : official journal of the Brazilian Society of Urology",
issn = "1677-5538",
publisher = "Brazilian Society of Urology",
number = "6",

}

TY - JOUR

T1 - Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis

T2 - A contemporary evaluation

AU - Westerman, Mary E.

AU - Boorjian, Stephen A.

AU - Linder, Brian J.

PY - 2016

Y1 - 2016

N2 - Introduction: Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regarding safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort. Materials and Methods: We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation. Results: Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95%). Alum use decreased patient's transfusion requirement, with 82% (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59% (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60%) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5%) remained without additional treatment for HC. Adverse effects were reported in 15 patients (38%), with bladder spasms representing the most common event (14/40; 35%). No clinical evidence of clinically significant systemic absorption was detected. Conclusion: Intravesical alum therapy is well-tolerated, with resolution of HC in approximately 60% of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.

AB - Introduction: Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regarding safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort. Materials and Methods: We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation. Results: Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95%). Alum use decreased patient's transfusion requirement, with 82% (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59% (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60%) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5%) remained without additional treatment for HC. Adverse effects were reported in 15 patients (38%), with bladder spasms representing the most common event (14/40; 35%). No clinical evidence of clinically significant systemic absorption was detected. Conclusion: Intravesical alum therapy is well-tolerated, with resolution of HC in approximately 60% of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.

KW - Cystitis

KW - Hematuria

KW - Radiotherapy

KW - Urinary Bladder

UR - http://www.scopus.com/inward/record.url?scp=85006142013&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85006142013&partnerID=8YFLogxK

U2 - 10.1590/S1677-5538.IBJU.2015.0588

DO - 10.1590/S1677-5538.IBJU.2015.0588

M3 - Article

VL - 42

SP - 1144

EP - 1149

JO - International braz j urol : official journal of the Brazilian Society of Urology

JF - International braz j urol : official journal of the Brazilian Society of Urology

SN - 1677-5538

IS - 6

ER -