Gonzalez, CM; Case, JR; Nadler, RB
Hemorrhagic cystitis represents a potentially devastating problem in urology with a mortality rate approaching 4%.(1) Although many factors have been attributed to the cause of this disease, the most common causes continue to be cyclophosphamide based chemotherapy and external beam radiotherapy. If preventive measures fail and hemorrhagic cystitis develops, patients usually respond to conservative treatment, such as bladder catheterization, clot evacuation or continuous bladder irrigation. If bleeding continues, intravesically instilled bladder astringents, such as alum, prostaglandin and silver nitrate, have proved to provide good results with little morbidity.(1-4)
Treatment refractory bleeding represents a more difficult and challenging problem. For treatment refractory disease oral conjugated estrogen, hyperbaric oxygen, aminocaproic acid, intravesical formalin and bilateral hypogastric arterial embolization have been reported with varying success and morbidity, although the gold standard remains supravesical ;urinary diversion.(1,2,5-7) We present a minimally invasive method of supravesical urinary diversion for transfusion dependent, treatment refractory hemorrhagic cystitis.