title: Safety and efficacy of intravesical alum for intractable hemorrhagic cystitis: A contemporary evaluation.
abstract: BACKGROUND
  Hemorrhagic cystitis (HC) represents a challenging clinical entity. While various intravesical agents have been utilized in this setting, limited data exist regard¬ing safety or efficacy. Herein, then, we evaluated the effectiveness and complications associated with intravesical alum instillation for HC in a contemporary cohort.
  
  
  METHODS
  We identified 40 patients treated with intravesical alum for HC between 1997-2014. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after alum instillation.
  
  
  RESULTS
  Median patient age was 76.5 years (IQR 69, 83). Pelvic radiation was the most common etiology for HC (n=38, 95%). Alum use decreased patient's transfusion requirement, with 82% (32/39) receiving a transfusion within 30 days before alum instillation (median 4 units) versus 59% (23/39) within 30 days after completing alum (median 3 units) (p=0.05). In total, 24 patients (60%) required no additional therapy prior to hospital discharge. Moreover, at a median follow-up of 17 months (IQR 5, 38.5), 13 patients (32.5%) remained without additional treatment for HC. Adverse ef¬fects were reported in 15 patients (38%), with bladder spasms representing the most common event (14/40; 35%). No clinical evidence of clinically significant systemic absorption was detected.
  
  
  CONCLUSIONS
  Intravesical alum therapy is well-tolerated, with resolution of HC in ap¬proximately 60% of patients, and a durable response in approximately one-third. Given its favorable safety/efficacy profile, intravesical alum may be considered as a first-line treatment option for patients with HC.
authors: Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Mary E
authors: ME
authors: Westerman
authors: Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Stephen A
authors: SA
authors: Boorjian
authors: Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Brian J
authors: BJ
authors: Linder
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000534:Alum Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D000535:Aluminum / Q000097:blood; D015331:Cohort Studies; D003556:Cystitis / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D000534:Alum Compounds; C041524:aluminum sulfate; D000535:Aluminum
keywords: Cystitis; Hematuria; Urinary Bladder