From the Guidelines
Management of hemorrhagic cystitis without a Foley catheter due to infection risk involves prioritizing oral or intravenous hydration and pain management, as these approaches can help reduce bladder irritation and control bleeding. When a Foley catheter cannot be inserted due to infection risk, several management options are available for hemorrhagic cystitis. Key considerations include:
- Oral or intravenous hydration to dilute urine and reduce bladder irritation
- Pain management using NSAIDs or opioids as needed
- Antifibrinolytics such as tranexamic acid to help stabilize clots
- Intravesical therapies administered through a temporary catheter with immediate removal after instillation, including alum, silver nitrate, or prostaglandins
- Systemic treatments like conjugated estrogens to promote vascular integrity, and WF10 for radiation-induced cases
- Hyperbaric oxygen therapy for severe cases to reduce inflammation and promote healing, as supported by the most recent and highest quality studies 1. It's essential to weigh the benefits and risks of each approach, considering the patient's individual situation and the potential for infection, as highlighted in studies focusing on infection prevention and management 1. However, the primary goal is to manage hemorrhagic cystitis effectively while minimizing the risk of infection, which can be achieved through careful patient assessment and the implementation of evidence-based strategies, with a focus on the most recent guidelines and recommendations 1.
From the Research
Management Options for Hemorrhagic Cystitis
When a Foley catheter cannot be inserted due to infection risk, several management options can be considered for hemorrhagic cystitis:
- Conservative strategies:
- Bladder fulguration
- Continuous irrigation 2
- Intravesical instillations:
- Various agents can be used to control bleeding and promote healing 3
- Embolization:
- Selective embolization of the vesical arteries can be an effective treatment option for severe hemorrhagic cystitis 4
- Urinary diversion:
- May be necessary in some cases to manage intractable bleeding 2
- Surgical options:
- Cystectomy and ileal conduit may be considered in severe cases where other treatments have failed 5
- Systemic therapies:
- May be used to control bleeding and manage symptoms 3
- Non-pharmacologic therapies:
Considerations for Treatment
The choice of treatment will depend on the severity of bleeding, the underlying cause of hemorrhagic cystitis, and the patient's overall health status. It is essential to consider each clinical scenario when formulating management strategies to provide the highest quality of care to patients 2.