Montgomery Brian D, Boorjian Stephen A, Ziegelmann Matthew J, Joyce Daniel D, Linder Brian J
Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
Turk J Urol. 2016 Sep;42(3):197-201. doi: 10.5152/tud.2016.38445.
Hemorrhagic cystitis is a challenging clinical entity with limited evidence available to guide treatment. The use of intravesical silver nitrate has been reported, though supporting literature is sparse. Here, we sought to assess outcomes of patients treated with intravesical silver nitrate for refractory hemorrhagic cystitis.
We identified nine patients with refractory hemorrhagic cystitis treated at our institution with intravesical silver nitrate between 2000-2015. 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 silver nitrate instillation prior to hospital discharge.
Median patient age was 80 years (IQR 73, 82). Radiation was the most common etiology for hemorrhagic cystitis 89% (8/9). Two patients underwent high dose (0.1%-0.4%) silver nitrate under anesthesia, while the remaining seven were treated with doses from 0.01% to 0.1% via continuous bladder irrigation for a median of 3 days (range 2-4). All nine patients (100%) had persistent hematuria despite intravesical silver nitrate therapy, requiring additional interventions and red blood cell transfusion during the hospitalization. There were no identified complications related to intravesical silver nitrate instillation.
Although well tolerated, we found that intravesical silver nitrate was ineffective for bleeding control, suggesting a limited role for this agent in the management of patients with hemorrhagic cystitis.
出血性膀胱炎是一种具有挑战性的临床病症，可供指导治疗的证据有限。膀胱内使用硝酸银已有报道，但其支持文献较少。在此，我们试图评估膀胱内使用硝酸银治疗难治性出血性膀胱炎患者的疗效。
我们确定了2000年至2015年间在我院接受膀胱内硝酸银治疗的9例难治性出血性膀胱炎患者。所有患者先前使用生理盐水持续膀胱冲洗和清除血凝块均失败。治疗成功定义为在出院前硝酸银灌注后除生理盐水冲洗外无需额外治疗。
患者年龄中位数为80岁（四分位间距73，82）。放疗是出血性膀胱炎最常见的病因，占89%（8/9）。2例患者在麻醉下接受高剂量（0.1%-0.4%）硝酸银治疗，其余7例通过持续膀胱冲洗接受0.01%至0.1%剂量治疗，中位时间为3天（范围2-4天）。尽管接受了膀胱内硝酸银治疗，所有9例患者（100%）仍有持续性血尿，住院期间需要额外干预和输注红细胞。未发现与膀胱内硝酸银灌注相关的并发症。
尽管耐受性良好，但我们发现膀胱内硝酸银对控制出血无效，提示该药物在出血性膀胱炎患者管理中的作用有限。
