hemorrhagic cystitis uptodate

[109] Formalin coagulates the bleeding bladder surface by hydrolyzing and cross-linking proteins. 56(2):114-6. 2015 Sep 9. Urology. [Medline]. Pilot study to test the efficacy and safety of activated recombinant factor VII (NovoSeven) in the treatment of refractory hemorrhagic cystitis following high-dose chemotherapy. Urology. Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges, Factors affecting the outcome of related allogeneic hematopoietic cell transplantation in patients with Fanconi Anemia, A practical approach to the management of radiation-induced hemorrhagic cystitis, Hemorrhagic cystitis: A challenge to the urologist, Risk factors and predictors of severity score and complications of pediatric hemorrhagic cystitis, Scoping review and meta-analysis of hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis, Visible bleeding with large clots that block the urinary tract and require removal, Getting up multiple times a night to urinate, Vague pain in the lower abdomen above the pubic area of the pelvic bone, Cyclophosphamide is used primarily to treat. Hemorrhagic cystitis is serious when accompanied by significant bleeding. Barouch DH, Faquin WC, Chen Y, Koralnik IJ, Robbins GK, Davis BT. [Medline]. Bone Marrow Transplant. [166, 167, 168, 169] or with use of the argon beam coagulator have been described as successful measures. 1999 Nov. 57(4):287-92. Shah R, Simonett JM, Lyons RJ, Rao RC, Pennesi ME, Jain N. Disease Course in Patients With Pentosan Polysulfate Sodium-Associated Maculopathy After Drug Cessation. Diagnosis algorithm. [Medline]. Cytomegalovirus-induced hemorrhagic cystitis following bone marrow transplantation. 2040239-overview Pain or burning when passing your urine 4. Sakurada M, Kondo T, Umeda M, Kawabata H, Yamashita K, Takaori-Kondo A. 2002 May. This surgical procedure is associated with a low success rate because most cases are associated with diffuse venous bleeding that cannot be controlled with embolization. 149(4):835-7. [Medline]. Vitamin B-12 deficiency and steatorrhea have been reported in patients in whom the distal ileum and ileocecal valve were used for diversion. J Clin Microbiol. 1990 May. [Medline]. [156] A study of leflunomide for the treatment of BK virus–associated hemorrhagic cystitis in allogeneic hematopoietic stem cell transplantation recipients found that the drug was potentially effective and without significant toxicity. Hemorrhagic cystitis or haemorrhagic cystitis is an inflammation of the bladder defined by lower urinary tract symptoms that include dysuria, hematuria, and hemorrhage. 153(3 Pt 1):637-40. Intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. 40(4):528-37. 2006 Jan. 25(1):84-5. Drugs. Successful treatment of severe hemorrhagic cystitis after hemopoietic cell transplantation by selective embolization of the vesical arteries. Hudson RG, Cain MP. JAMA Ophthalmol. 1999 Oct. 32(10):1211-5. Transplantation. 2018 Jul. Did You Know That a Stroke Interferes With Urination? [Medline]. J Urol. Successful vidarabine therapy for adenovirus type 11-associated acute hemorrhagic cystitis after allogeneic bone marrow transplantation. Adequate hydration to induce brisk diuresis, continuous bladder irrigation, and prophylactic dosing of mesna are important preventive measures. Hemorrhagic cystitis is characterized by large quantities of visible blood in the urine. Lee HJ, Pyo JW, Choi EH, Ha IS, Cheong HI, Choi Y, et al. In general, cystitis caused by exposure to chemotherapeutic drugs can be expected to resolve after discontinuation of the agent and treatment with irrigation/fulguration. J Urol. [Medline]. [Medline]. In 2008, it was estimated that 500 million people worldwide were infected with sexually transmitted viruses such as herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) or had sexually transmitted infections such as gonorrhea, chlamydia, syphilis, mycoplasma, and trichomoniasis.7 More than 300,000 U.S. cases of infection with Neisseria gonorrhoeae are reported to the Centers for Disease Control an… [Medline]. The oncology service must be made aware of the patient's history of hemorrhagic cystitis and must maximize preventive measures before the patient is given any additional oncologic therapy. 11 (3-4):E79-E82. Hemorrhagic adenovirus cystitis after renal transplantation. Clin Infect Dis. Can Urol Assoc J. [Medline]. Imaging findings of hemorrhagic cystitis in pediatric oncology patients. Curr Opin Support Palliat Care. 2006 Dec. 38(12):825-8. [Medline]. 2016 Jun 27. 1992 Mar. J Urol. Oral erythromycin base and neomycin are also administered upon completion of the mechanical bowel preparation. [Medline]. [Medline]. 2006 Aug. 176(2):620-1. [Medline]. Reduced recurrence of late hemorrhagic radiation cystitis by WF10 therapy in cervical cancer patients: a multicenter, randomized, two-arm, open-label trial. 2003 Feb. 44(1):163-5. Levine LA, Jarrard DF. [151], Reviews of intravenous or intravesical cidofovir for hemorrhagic cystitis due to BK polyomavirus in allogeneic stem cell transplant recipients have reported at least partial response in approximately two thirds of patients. Evaluation of uroprotective efficacy of amifostine against cyclophosphamide induced hemorrhagic cystitis. Am J Kidney Dis. In the absence of obstructing clots and if the patient is voiding well, hydration with careful observation may be the only treatment required. Tomonari A, Takahashi S, Ooi J, Fukuno K, Takasugi K, Tsukada N, et al. 35(5):529-30. Treatment of BK virus-associated hemorrhagic cystitis and simultaneous CMV reactivation with cidofovir. [Medline]. Biochem Pharmacology. 2013 Nov. 28 (6):743-5. Batista CK, Mota JM, Souza ML, Leitão BT, Souza MH, Brito GA, et al. Prompt recognition and treatment of urinary tract infections is also a prudent preventive measure. Secondary to "bootleg" methaqualone. Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges. Risperidone associated hemorrhagic cystitis. Initial irrigations may be performed manually with sterile water; water is preferable to sodium chloride solution because it helps to lyse red blood cells and clots. Urology. Viruses associated with hemorrhagic cystitis include: Among the bacterial organisms known to cause hemorrhagic cystitis are: While rare, hemorrhagic cystitis may develop as a result of parasitic diseases such as schistosomiasis, a disease caused by parasitic worms, or Echinococcosis, caused by a parasitic tapeworm, or fungal infections, such as from Candida albicans or Cryptococcus neoformans. Veerasarn V, Khorprasert C, Lorvidhaya V, Sangruchi S, Tantivatana T, Narkwong L, et al. Hemorrhagic cystitis is a bladder condition that causes pain and hematuria (blood in the urine). Bone Marrow Transplant. Candida albicans and Candida glabrata have been reported to cause cystitis that is often hemorrhagic … Candida infections of the bladder and kidneys … [3 to 6 mg/kg] orally daily). Percutaneous nephrostomy for treatment of intractable hemorrhagic cystitis. Schneidewind L, Neumann T, Kranz J, Knoll F, Pelzer AE, Schmidt C, et al. [Medline]. [Medline]. Combined intravenous and oral mesna in outpatients treated with ifosfamide. Evaluation of Hyperbaric Oxygen Therapy in the Treatment of Radiation-induced Hemorrhagic Cystitis. McAninch JW, Lue TF, eds. Always seek … Effects of tadalafil on hemorrhagic cystitis and testicular dysfunction induced by cyclophosphamide in rats. [163], In extreme cases, when all other treatment options have failed, selective hypogastric branch artery embolization can be considered. After hemorrhagic cystitis develops, the treatment follows the same guidelines irrespective of the cause, although most infectious cases resolve with appropriate antibiotics. Kapelushnik J, Verstandig A, Or R, Meretyk S, Drakos P, Naparstek E, et al. Riachy E, Krauel L, Rich BS, McEvoy MP, Honeyman JN, Boulad F, et al. Bratsas KS, Stephanides AA, Spyropoulos E, Zachariades BP, Androulakakis PA. Hyperbaric oxygen therapy for cyclophosphamide induced refractory hemorrhagic cystitis in a child. Gomes TN, Santos CC, Souza-Filho MV, Cunha FQ, Ribeiro RA. Urol Int. 2017 Mar-Apr. [Medline]. 103(12):4674-80. Habs MR, Schmähl D. Prevention of urinary bladder tumors in cyclophosphamide-treated rats by additional medication with the uroprotectors sodium 2-mercaptoethane sulfonate (mesna) and disodium 2,2'-dithio-bis-ethane sulfonate (dimesna). 2003 May. Nieh, Peter T and Marshall, Fray F. Surgery of Bladder Cancer. 1990 Jan. 143(1):92-4. [Medline]. Singh D, Kiberd B, Gupta R, Alkhudair W, Lawen J. Polyoma virus-induced hemorrhagic cystitis in renal transplantation patient with polyoma virus nephropathy. Diseases & Conditions, 2002 [Medline]. The amount of blood can range from a minute amount that occurs occasionally to frank bright red blood that occurs … Watson RA. 2005 Aug. 36(3):265-6. 2005 Sep. 66(3):641-3. [159, 160, 161, 162, 104, 105] Antiviral agents should be added to bladder irrigation when a viral etiology is suspected or confirmed. 31(7):615-6. [Medline]. [Medline]. [Medline]. Administer MESNA (2-Mercaptoethanesulfonate sodium), a medication that helps protect your bladder from the effects of acrolein. INTRODUCTION — Hemorrhagic cystitis (HC) is a sterile cystitis that is characterized by gross hematuria. Giné E, Rovira M, Real I, Burrel M, Montaña J, Carreras E, et al. 79(5):624. 2006 Mar. Hemorrhagic cystitis is defined by lower urinary tract symptoms that include hematuria and irritative voiding symptoms. Inadvertent urethral insertion of a contraceptive suppository. 2006 Jul. Other prostaglandins have also been used intravesically or parenterally in the treatment of pain associated with hemorrhagic cystitis, including prostaglandin E1 and prostaglandin E2. Stillwell TJ, Benson RC Jr. Cyclophosphamide-induced hemorrhagic cystitis. Biol Blood Marrow Transplant. [Medline]. 9th. 2000 Mar. Bonney's blue cystitis: a warning. Hematuria may develop during treatment or it may develop months or years later due to ischemia (insufficient blood supply) in the mucosal lining of the bladder that causes ulceration and bleeding. The damage may also lead to the growth of new vessels in damaged areas—the vessels can be fragile and may leak easily.. Biol Blood Marrow Transplant. Erard V, Storer B, Corey L, Nollkamper J, Huang ML, Limaye A, et al. 2002 Yusuf U, Hale GA, Carr J, Gu Z, Benaim E, Woodard P, et al. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjA1NjEzMC10cmVhdG1lbnQ=, Selective hypogastric artery embolization (very rarely effective), Activated thrombin and fibrin agents (eg, Evicel, FloSeal), Angiogenesis inhibitors (for cyclophosphamide cystitis). Hematuria (blood in the urine) 2. Cyclophosphamide induced hemorrhagic cystitis. Pediatr Nephrol. J Urol. Payne H, Adamson A, Bahl A, Borwell J, Dodds D, Heath C, et al. [Medline]. Alum and silver nitrate, which are astringents, work by forming precipitates over the bleeding surfaces of the bladder wall. Haines HL, Laskin BL, Goebel J, et al. Dall'Era MA, Hampson NB, Hsi RA, Madsen B, Corman JM. 1994 Sep. 44(3):322-8. 7(7):388-94. In patients with refractory hemorrhagic cystitis, surgical intervention is warranted (see the management algorithm below). [18]. Mayersak JS, Viviano CJ. Mesna can be given either orally or intravenously, and its routine concurrent administration has been recommended in the treatment of patients receiving cyclophosphamide and ifosfamide chemotherapy. Kanat O, Kurt E, Yalcinkaya U, Evrensel T, Manavoglu O. 2003 Oct. 22(10):928-9. [Medline]. Schneidewind L, Neumann T, Schmidt CA, Krüger W. Comparison of intravenous or intravesical cidofovir in the treatment of BK polyomavirus-associated hemorrhagic cystitis following adult allogeneic stem cell transplantation-A systematic review. [Medline]. 2005 Aug 1. Int J Urol. 159(3):1044. Ison MG. Adenovirus infections in transplant recipients. 22 (4):723-30. Kitabayashi A, Hirokawa M, Kuroki J, Nishinari T, Niitsu H, Miura AB. 15(9):1103-6. Prevention of hemorrhagic cystitis following allogeneic bone marrow transplant preparative regimens with cyclophosphamide and busulfan: role of continuous bladder irrigation. The following tests and exams play a key role in finding a cause for blood in your urine: 1. [Medline]. In: Wein, Alan J; Kavoussi Louis R; Novick, Andrew C; Partin, Alan W; Peters, Craig A. Campbell-Walsh Urology. Surgical intervention other than cystoscopy with cauterization is reserved for cases in which medical management fails. [Medline]. [103] Both agents are somewhat caustic to the bladder, and alum can cause bladder wall necrosis and even perforation. Cyclophosphamide-associated carcinoma of urothelium: modalities for prevention. Of 69 children with AHC, adenovirus type 11 was recovered from the urine of ten, and adenovirus type 21 from the urine of two. Radiation therapy to the pelvis can also cause hemorrhagic cystitis, especially when used in combination with these chemotherapy drugs. 31(10):923-5. J Urol. 2003 Nov. 10(11):595-602. Bone Marrow Transplant. The diagnosis of viral infection is usually determined by viral cultures. [Medline]. Nagafuji K, Aoki K, Henzan H, Kato K, Miyamoto T, Eto T, et al. Chen XC, Liu T, Li JJ, He C, Meng WT, Huang R. Efficacy and safety of leflunomide for the treatment of BK virus-associated hemorrhagic cystitis in allogeneic hematopoietic stem cell transplantation recipients. J Urol. 1996 Feb. 155(2):685. [Medline]. 1994 Apr. [Medline]. Rarely, alum irrigation causes encephalopathy and acidosis in patients with renal insufficiency, in whom serum aluminum level monitoring is advisable. J Urol. Human herpesvirus-6 as a possible cause of encephalitis and hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation. 2003 Jun. 2019 Sep 5. 1996. Nguyen ML, Borochovitz D, Thomas G, McClure T, Ruben FL. 2014;191(1):186-92. doi:10.1016/j.juro.2013.08.007, Cardinal J, Slade A, Mcfarland M, Keihani S, Hotaling JN, Myers JB. Although continuous bladder irrigation with saline solution cannot replace manual irrigation for removal of the clots, it can aid in preventing further clotting. 13(5):1103-9. 233101-overview Vieira MM, Brito GA, Belarmino-Filho JN, Macedo FY, Nery EA, Cunha FQ, et al. [134], Treatment with estrogen has been shown to control hemorrhagic cystitis in children, adolescents, and adults with hemorrhagic cystitis due to various causes, including cyclophosphamide chemotherapy. 1990. Ruggeri A, Roth-Guepin G, Battipaglia G, Mamez AC, Malard F, et al. Cyclophosphamide induced hemorrhagic cystitis successfully treated with pentosanpolysulphate. Urol Int. [Medline]. [Medline]. Even if hemorrhagic cystitis does not develop during the use of cyclophosphamide, the patient’s lifetime risk of developing bladder cancer is increased 9-fold after receiving the agent. Blood. Hemorrhagic cystitis (HC) is a common complication of HSCT described in up to 40%–50% of patients within first year of allogeneic HSCT. Hemorrhagic cystitis associated with BKV in patients with refractory acute lymphoblastic leukemia. [Medline]. Successful application of epidermal growth factor for treatment of hemorrhagic cystitis after bone marrow transplantation. 1999 May. Kim YJ, Kim DW, Lee DG, Park ST, Park YH, Min CK, et al. [163] Subtotal cystectomy with augmentation of the bladder with ileum is another option in these patients. 2003 Apr. 61(3):451-7. Ann Hematol. 1999 Mar. Pediatr Infect Dis J. Purves JT, Graham ML, Ramakumar S. Application of fibrin glue to damaged bladder mucosa in a case of BK viral hemorrhagic cystitis. In severe, refractory cases of hemorrhagic cystitis, formalin can be instilled in the bladder. Tirindelli MC, Flammia GP, Bove P, Cerretti R, Cudillo L, De Angelis G, et al. [Medline]. It can be caused by a bacterial or viral infection or as a result of radiation, cancer chemotherapy, or immunosuppressive medication. 2007 Jun. Am J Dis Child. Mathews R, Rajan N, Josefson L, Camporesi E, Makhuli Z. Hyperbaric oxygen therapy for radiation induced hemorrhagic cystitis. For persistent hematuria, the bladder can be irrigated with a variety of agents. Heath JA, Mishra S, Mitchell S, Waters KD, Tiedemann K. Estrogen as treatment of hemorrhagic cystitis in children and adolescents undergoing bone marrow transplantation. [Medline]. Transplantation. Loss of bladder control (incontinence) 6. Frequent or urgent need to empty your bladder 7. Continuous bladder irrigation in combination with mesna, hydration, and urinary alkalization during bone marrow transplantation may prevent hemorrhagic cystitis. [Medline]. Speak to your healthcare provider if you have any concerns about upcoming cancer treatments or at the first sign of any urinary symptoms. Lifelong follow-up may be required. 2011 Jul 31. 1993 Jan. 16(1):142-4. Acta Haematol. Bedi A, Miller CB, Hanson JL, Goodman S, Ambinder RF, Charache P, et al. Phenotypic Spectrum of Pentosan Polysulfate Sodium-Associated Maculopathy: A Multicenter Study. Biol Blood Marrow Transplant. 2016 Aug 24. 2018 Sep. 24 (9):1901-1905. Walker RD. [Medline]. Fulguration with a neodymium-doped yttrium aluminium garnet (Nd:YAG) laser has been used for hemorrhagic cystitis. Hemorrhagic cystitis, chemotherapy, and bladder toxicity. If you have ever experienced the discomfort of a serious urinary tract infection, you have an idea of the nature of some of the symptoms of hemorrhagic cystitis. Bone Marrow Transplant. [Medline]. This treatment is better for radiation-induced hemorrhagic cystitis than for cyclophosphamide-induced hemorrhagic cystitis. Sarnak MJ, Long J, King AJ. [Full Text]. 1990 Jan. 143(1):1-9. Uroprotective effect of pentoxifylline in cyclophosphamide-induced hemorrhagic cystitis in rats. Konety BR, Carroll PR. 2006 Jan-Mar. Intravesical formalin instillation must be performed with the patient under anesthesia because it is otherwise excruciatingly painful. [Medline]. 2002 May. J Urol. Br J Urol. 2008 Jan-Feb. 26(1):43-6. [6, 10, 95]. [Medline]. It can develop as a complication of cancer treatment, including chemotherapy and radiation, or it can result from bladder infections. Philippe M, Ranchon F, Gilis L, Schwiertz V, Vantard N, Ader F, et al. Suprapubic cystotomy as treatment for severe hemorrhagic cystitis after bone marrow transplantation. J Urol. 2016 Apr. Use of dexamethasone with mesna for the prevention of ifosfamide-induced hemorrhagic cystitis. [Medline]. 2017 May. 2014 Aug 11. The risk of polyomavirus BK-associated hemorrhagic cystitis after allogeneic hematopoietic SCT is associated with myeloablative conditioning, CMV viremia and severe acute GVHD. [114], Although radiation-induced hemorrhagic cystitis cannot be prevented at this time, encouraging research with pentosan polysulfate sodium is ongoing. 1996 May. Clin Infect Dis. It is very painful to have cystitis as this can become acute hemorrhagic cystitis if there is a delay in treatment. 93(1):55-62. [Medline]. To date, the causes of hemorrhagic cystitis, defining its types, are divided into infectious and non-infectious. Intravesical formalin for hemorrhagic cystitis: A contemporary cohort. Antimicrob Agents Chemother. [Medline]. The active thiol metabolite is thought to scavenge reactive oxygen species generated in irradiated cells. If the patient demonstrates difficulty with urination, clots are likely occluding the bladder outlet and clot evacuation is indicated. Empiric antibiotics to cover the usual flora are indicated during initiation of other measures. J Urol. 37(5):523-6. J Urol. Physical exam, which includes a discussion of your medical history. Clin Infect Dis. Bone Marrow Transplant. Shakiba E, Yaghobi R, Ramzi M. Prevalence of viral infections and hemorrhagic cystitis in hematopoietic stem cell transplant recipients. NCCN Guidelines: Prevention and Treatment of Cancer-Related Infections version 2.2020. Ziegelmann MJ, Boorjian SA, Joyce DD, Montgomery BD, Linder BJ. Patients may require several treatments. Epsilon aminocaproic acid can be used either orally or parenterally. [123] has demonstrated moderate effectiveness. Medscape Education. Application of argon beam coagulation in urological surgery. Biol Blood Marrow Transplant. 2007 Jan. 59(1):71-7. [164] Intravesical balloons to tamponade the vessels have resulted in some transient improvement; however, the therapy is not widely accepted. All clots must be removed before continuous irrigation is started to avoid overdistention and potential bladder ruptures. [124, 125]. Formalin treatment of refractory hemorrhagic cystitis in systemic lupus erythematosus. J Urol. The addition of dexamethasone with mesna may improve the results. 1999 Dec. 24(11):1259-60. 131(5):960-2. 2005 Oct. 11(10):797-804. 2 (3):199-208. 1995 May. Ann Hematol. Successful treatment of severe hemorrhagic cystitis with selective vesical artery embolization. Russo P. Urologic emergencies in the cancer patient. [Medline]. 1998 Jul. [Medline]. 1999 Jun. J Urol. 43 (3):489-495. David Stanley, MD is a member of the following medical societies: American Medical Association, American Urological AssociationDisclosure: Nothing to disclose. If you have symptoms of cystitis, talk to your doctor as soon as possible. [Medline]. 2003 Nov. 32(9):903-7. Arch Pathol Lab Med. Clot evacuation can be performed at the bedside by carefully placing a large, stiff-walled hematuria catheter. [Medline]. Haldar S, Dru C, Bhowmick NA. [Medline]. J Urol. 16(5):958-9. Bone Marrow Transplant. 52(2):121-2. The latter often requires the creation of a longer conduit than would be performed otherwise. 1996 Jun. Even if your bleeding was discovered through urine testing (urinalysis), you're likely to have another test to see if your urine still contains red blood cells. Pharmacological and histopathological study of cyclophosphamide-induced hemorrhagic cystitis - comparison of the effects of dexamethasone and Mesna. Hoffman JA, Shah AJ, Ross LA, Kapoor N. Adenoviral infections and a prospective trial of cidofovir in pediatric hematopoietic stem cell transplantation. 1994 Jan. 151(1):152-3. 27(3):284-98. 2007 Apr. Yigitaslan S, Ozatik O, Ozatik FY, Erol K, Sirmagul B, Baseskioglu AB. 2004 Oct. 172(4 Pt 1):1348. 59(5):643-50. [Medline]. Radical cystectomy to manage cancer usually involves anterior exenteration in female patients and cystoprostatectomy in male patients. 2005 Aug 1. For the treatment of hemorrhagic cystitis† induced by cyclophosphamide therapy, radiation therapy, or interstitial cystitis. [Medline]. [Medline]. Mechanisms of hemorrhagic cystitis. Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer. 149(6):1449-51. Epinephrine promotes hemostasis in rats with cyclophosphamide-induced hemorrhagic cystitis. Cannon J, Linke CA, Cos LR. Some have proposed the use of epsilon aminocaproic acid (Amicar) as an aid to stopping small vessel bleeding at this point. Spach DH, Bauwens JE, Myerson D, Mustafa MM, Bowden RA. Give you lots of IV fluids to help the chemotherapeutic medications and their byproducts pass through your bladder more quickly, Schedule your chemotherapy early in the day so you have an opportunity to clear it from your bladder before resting for the night, Encourage you to try to urinate at least every hour, Administer diuretics, which help keep urine flowing to clear the chemotherapeutic medications and their byproducts from your bladder, Insert a urinary catheter so the chemotherapeutic and their byproducts are continuously removed from your bladder before they have the opportunity to cause ulceration. When the body breaks down either of these drugs, acrolein, a byproduct, is produced, Acrolein is filtered out of the blood by the kidneys and becomes highly concentrated in the urine that's stored inside the bladder. In the absence of obstructing clots and if the patient is voiding well, hydration with careful observation may be the only treatment required. [110, 111, 112, 113] Placement via cutaneous vesicostomy has also been described. These patients are typically hospitalized and put on bed rest during their therapeutic interventions. [157]. 2001 Aug. 28(4):405-7. [Medline]. Geetha D, Tong BC, Racusen L, Markowitz JS, Westra WH. Hemorrhagic cystitis following accidental overdose of methenamine mandelate. Lakhani A, Raptis A, Frame D, Simpson D, Berkahn L, Mellon-Reppen S, et al. [Full Text]. 1995 Sep-Oct. 80(5):421-5. Detection of BK virus and adenovirus in the urine from children after allogeneic stem cell transplantation. In immunocompromised patients, who are at high risk for infections, results from the bacterial and viral cultures guide the selection of antibiotic and antiviral therapy. Thank you, {{form.email}}, for signing up. Br J Urol. Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center