The management of haemorrhagic cystitis with sodium pentosan polysulphate.
OBJECTIVE
To assess the use of sodium pentosan polysulphate (SPP) for haemorrhagic cystitis (HC), a potentially life-threatening side-effect in patients treated with pelvic radiotherapy or cyclophosphamide, and which can be difficult to manage as patients often have significant comorbidity.


METHODS
Between September 1991 and December 2000, 60 consecutive patients (24 women and 36 men) with haemorrhagic cystitis were primarily treated with SPP; 53 patients had had radical radiotherapy for pelvic malignancy and seven systemic cyclophosphamide. All patients were screened for blood dyscrasia and residual/primary urothelial malignancy with imaging, urine cytology and cystoscopy.


RESULTS
In all, 51 patients were available for follow-up; the median (range) interval between completing treatment and developing haematuria was 4.5 (0.08-39.4) years, the duration of treatment 180 (21-1745) days and patients were followed for 450 (19-4526) days from the onset of haematuria. All patients were started on SPP at an initial dose of 100 mg three times daily. In 21 patients the dose was gradually reduced to a maintenance dose of 100 mg and in 10 further patients SPP was stopped because the haematuria stopped completely. Twenty patients died while on treatment from causes not directly related to their haematuria.


CONCLUSIONS
We recommend the use of SPP as the primary method of managing haemorrhagic cystitis associated with pelvic radiotherapy or systemic chemotherapy.
Sandhu
Sarbjinder S
SS
Department of Urology, The Royal Marsden Hospital, London, UK.
Goldstraw
Miles
M
Woodhouse
Christopher R J
CR
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003556:Cystitis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006417:Hematuria / Q000188:drug therapy / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010386:Pelvic Neoplasms / Q000532:radiotherapy; D010426:Pentosan Sulfuric Polyester / Q000627:therapeutic use*; D011832:Radiation Injuries / Q000188:drug therapy*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000528:radiation effects*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D010426:Pentosan Sulfuric Polyester