From the Guidelines
Hemorrhagic cystitis occurring four weeks after a transurethral resection of the prostate (TURP) is most likely caused by infection, radiation cystitis, or chemical irritation, and should be evaluated and managed promptly to prevent further complications. The initial management includes ensuring hemodynamic stability, adequate hydration, and possibly bladder irrigation with normal saline to evacuate clots. Oral or intravenous tranexamic acid may help control bleeding, as suggested by general medical knowledge. For symptomatic relief, anticholinergics like oxybutynin (5mg three times daily) or tolterodine (2mg twice daily) can reduce bladder spasms.
Causes and Risk Factors
The causes of hemorrhagic cystitis at this timeframe can be multifactorial, including:
- Infection: which may be related to the use of antimicrobial prophylaxis (AMP) in the postoperative period, although the evidence from 1 and 1 suggests that AMP may not have a significant effect on reducing postoperative urinary tract infections (UTIs) in patients undergoing transurethral resection of bladder tumors (TURB).
- Radiation cystitis: if the patient had prior radiation therapy, which can cause damage to the bladder lining and lead to hemorrhagic cystitis.
- Chemical irritation: which can occur due to the use of certain medications or substances that can irritate the bladder lining.
Management
The management of hemorrhagic cystitis includes:
- Empiric antibiotic therapy with fluoroquinolones like ciprofloxacin (500mg twice daily for 7-14 days) should be initiated after urine cultures are obtained, as suggested by general medical knowledge.
- Cystoscopy may be necessary to rule out residual prostate tissue, bladder neck contracture, or malignancy, especially if symptoms persist.
- The use of AMP in the postoperative period should be carefully considered, as the evidence from 1 and 1 suggests that it may not have a significant effect on reducing postoperative UTIs, and may even contribute to the development of antimicrobial resistance.
Conclusion is not allowed, so the answer will continue without one.
It is essential to note that the evidence from 1 and 1 is focused on TURB, and not specifically on TURP, but the principles of management and the potential causes of hemorrhagic cystitis can be applied to both procedures. The management of hemorrhagic cystitis should be individualized and based on the patient's specific needs and underlying conditions.
From the Research
Causes of Hemorrhagic Cystitis
- Hemorrhagic cystitis can be caused by various factors, including chemical and irradiation exposure, as well as toxic or infectious causes 2
- Radiation-induced hemorrhagic cystitis is a recognized possible side effect of therapeutic radiation administered for pelvic malignancies 3, 4
- Chemical compounds such as oxaphosphorines (cyclophosphamide, ifosfamide) can also cause hemorrhagic cystitis 2
Hemorrhagic Cystitis after TURP
- There is no direct evidence in the provided studies that links TURP to hemorrhagic cystitis four weeks after the procedure
- However, hemorrhagic cystitis can occur due to various etiologies, including infection, chemical exposure, malignancy, nephropathy, trauma, radiation therapy, and idiopathic etiology 5
Treatment Options
- Treatment options for hemorrhagic cystitis include clot extraction, continuous bladder irrigation, bladder instillations of haemostatic factors, formalin, hyperbaric oxygen therapy, arterial embolization, or salvage surgery 2, 3, 4
- The choice of treatment depends on the severity of bleeding and the underlying cause of hemorrhagic cystitis 5, 4