Conventional treatment

Mild urinary frequency, caused by a minor reduction in the bladder capacity, can be treated with antispasmodics192. Hemorrhagic cystitis require bladder irrigation through a transurethral catheter193.

For intractable hematuria, intravesical formalin instillation has been studied by several authors, with good results125'186'188'194-199. A preinstillation cystogram is necessary, to search a vesicoureteral reflux. General or intradural anesthesia is required. Contact time is ranged from 5 to 30 minutes125,188; after instillation bladder irrigation is performed. One of the most important published trial included 35 patients; different concentrations have been used: 1, 2 and 4%. Complete response has been observed in 31 patients after a single instillation; complication occurred in 31% of the patients. A 1% solution was as effective as higher concentration, and was associated with less morbidity194. Another retrospective study of 25 patients (15 cases of radiation cystitis) obtained the same results188. Potential complications include pain, dysuria, incontinence, extravasation, fistula125,186,188,199. Ureteral stenosis and or anuria, tubular necrosis, can ever occur, specially in the cases of vesicoureteral reflux200. The incidence of these complications is difficult to establish. Formalin instillation has been studied in several small retrospective trials and seems effective. The morbidity is correlated to the quality of the technique employed and the concentration solution.

Sodium pentosanpolysulfate has been shown to be effective in few non oni ono controlled studies201,202. Intravesical instillation of alum has been described, with a limited short term success203,204.

In a randomised trial, including 448 patients with bladder carcinoma (post-operative radiotherapy), superoxide dismutase significantly decreased acute and late cystitis and proctitis205.

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