Hemorrhagic Cystitis: Drugs for the treatment of Hemorrhagic Cystitis, Causes, Symptoms and Complications,Treatment

Hemorrhagic cystitis is defined   as a clinical picture characterized by an phlogistic process – sometimes infectious – at the level of the   bladder mucosa , associated with macroscopic hematuria; most of the time, hemorrhagic cystitis reflects a traumatic event affecting the bladder (e.g.  chemotherapy ) or the  administration  of a toxic substance.

Causes

What Causes Hemorrhagic Cystitis?

It is not uncommon for hemorrhagic cystitis to be the expression of inflammation , systemic or localized, supported by bacteria ( E. coli , S.  saprophyticus,  Klebsiella , Pseudomonas, etc. ),  viruses  ( Adenovirus , influenza A virus and  Cytomegalovirus ) or fungi (rarer); however, this variant of cystitis has been found in hemorrhagic diatheses,  generalized sepsis  and in some  syndromes . So-called “sterile” hemorrhagic cystitis is the expression of NON-infectious lesions, such as  radiotherapy  and chemotherapy.

• Risk factors:  AIDS ,  kidney stones  (rare),  urinary catheter ,  diabetes , gonorrhea,   incorrect  intimate hygiene , risky sexual intercourse ,  bladder tumors  (rare), use of the  diaphragm  and  spermicides , exaggerated use of intravaginal tampons.

Symptoms

How Does Hemorrhagic Cystitis Manifest Itself?

In the context of hemorrhagic cystitis, lesions affecting the  bladder wall  result in  inflammatory phenomena  associated with more or less serious hemorrhagic lesions. In general, the affected patient always complains  of blood in the urine  (hematuria), possibly associated with  dysuria ,   suprapubic  pain , pollakiuria, stranguria, bladder tenesmus .

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Medicines

The treatment for hemorrhagic cystitis depends on the underlying cause: when the disease is triggered by a bacterial insult,  antibiotic drugs  are the therapy of excellence. It is possible to choose broad-spectrum antibiotics if the pathogen responsible for hemorrhagic cystitis has not yet been identified with certainty; if the bacterium is isolated, the doctor will indicate a specific antibiotic. Similar discussion for hemorrhagic cystitis caused by viruses and  fungi : the former are eradicated with the administration of   specific  antivirals , while the fungi are killed with antifungals .

As we have analysed, hemorrhagic cystitis can also be of an extra-infectious nature, and depend on radiation, antineoplastic drugs or congenital malformations.

It is estimated that 5-30% of patients treated with  cyclophosphamide  or  ifosfamide develop bladder damage such as haemorrhagic cystitis: to avoid this inconvenience, it is recommended to undertake a specific therapy aimed at the PREVENTION of haemorrhagic cystitis.

Antibiotic Therapy For The Treatment Of Bacterial Hemorrhagic Cystitis

• Imipenem : the drug (class: beta-lactam antibiotics ) is used in therapy for the treatment of complicated bacterial infections of the urinary tract caused by Klebsiella and Pseudomonas .
• Third generation cephalosporins , also used in cases of severe bacterial infections caused by Gram-negative bacteria that are difficult to treat.
• Piperacillin: it is a semi-synthetic penicillin used in the treatment of complicated urinary tract infections (especially those caused by  Pseudomonas aeruginosa , Klebsiella , Enterobacter ,  Escherichia coli ,  Neisseria gonorrhoeae  etc.).

Antispasmodic Therapy For Hemorrhagic Cystitis

• Scopolamine butylbromide: the doctor may prescribe it for the symptomatic treatment of painful spasms that can accompany hemorrhagic cystitis.

Analgesic Drugs For The Control Of Pain Associated With Hemorrhagic Cystitis

There are several medicines of this type that can be used to relieve the pain caused by hemorrhagic cystitis. The doctor will prescribe the right active ingredient for each of his patients.

Systemic Hyperhydration In Case Of Hemorrhagic Cystitis

The objective of this therapy which involves the intravenous administration of fluids is to minimize the fatigue of the bladder detrusor muscle , while limiting, at the same time, the permanence of the  urine in contact with the injured mucosa. The doctor will establish how and in what way the administration is administered to the patient.

Drugs To Promote Diuresis

Forced diuresis constitutes another possible alternative or complementary therapy in the context of hemorrhagic cystitis .Therefore, diuretic drugs will be used . The doctor will establish the most suitable active ingredient for each patient.

Supportive Therapy With Blood Products For Hemorrhagic Cystitis

If necessary, the doctor may prescribe the administration of blood products to make up for any blood loss .

Alkalinization Of Urine For The Treatment Of Hemorrhagic Cystitis

Urine alkalinization is an effective method for the prevention of hemorrhagic cystitis in the context of chemotherapy treatments (taking methotrexate , cyclophosphamide and isophosphamide).

The specialist will decide which drug to use and in what dosage on a strictly individual basis for each patient.

Preventive Therapy For Hemorrhagic Cystitis In Cancer Patients

Some patients undergoing chemotherapy for the treatment of cancer are advised to administer certain drugs aimed at preventing haemorrhagic cystitis: anti-neoplastic medicines containing cyclophosphamide or ifosfamide, in fact, seem to increase the risk of causing haemorrhagic cystitis in those who take them. The dose-limiting toxicity of isofosfamide occurs mainly at the bladder and renal level.

In similar circumstances, it is advisable to administer the ingredient actio mesna (2-mercaptoethane-sodium sulphonate) intravenously at a dose equal to 20% of the dose of ifosfamide (or other oxazaphosphorines, such as cyclophosphamide) and subsequently after 4 and 8 hours.

Clearly, such drugs can only be administered by specialized healthcare personnel