title: Intravesical hemostatic gelatin matrix instillation in the management of intractable hematuria.
abstract: BACKGROUND
  The objective of the present study was to evaluate the safety and feasibility of a novel and minimally invasive approach, namely, intravesical instillation of a gelatin matrix hemostatic sealant (GMHS) in the management of intractable hematuria.
  
  
  METHODS
  Six consecutive patients with intractable hematuria not responding to standard treatment underwent intravesical instillation of a hemostatic bovine-derived gelatin matrix mixed with a human-derived thrombin component. The technical aspects of this approach are described in detail. The mean age of the patients was 70 ± 4 years (median 71, range 50-79). All patients had pelvic malignancy: 5 had prostate cancer, and 1, cervical cancer. Mean duration of hematuria before intervention was 6 ± 1 days (median 6, range 2-9). Mean preoperative hemoglobin level was 9.2 ± 0.5 g/dL (median 9.0, range 8.0-10.2). Complete control of bleeding was achieved in 5 patients (83%) and all 6 patients (100%) on day 1 and 7, respectively. At a mean follow-up of 10 ± 6 months (median 13, range 1-15), permanent control of bleeding was achieved in 5 of 6 patients (83%). A second GMHS instillation was performed in 1 patient (17%) and it was successful. During the follow-up, there were no complications related to GMHS instillation. Two patients died because of their underlying malignant disease.
  
  
  CONCLUSIONS
  Intravesical GMHS instillation appears to be a safe and feasible option in the management of intractable hematuria in the short-term.
authors.affiliation: Department of Urology, Medical University Vienna, Vienna, Austria. markus.margreiter@meduniwien.ac.at
authors.forename: Markus
authors.initials: M
authors.lastname: Margreiter
authors.forename: Varun
authors.initials: V
authors.lastname: Sharma
authors.forename: Ingrid
authors.initials: I
authors.lastname: Schauer
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Klingler
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D003558:Cystoscopy; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage*; D006417:Hematuria / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006454:Hemoglobins / Q000378:metabolism; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000150:complications*; D012008:Recurrence; D002583:Uterine Cervical Neoplasms / Q000150:complications*
chemical_list: C411004:FloSeal Matrix; D006454:Hemoglobins; D006490:Hemostatics