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.
- Pathogens – radiation – drugs → Lesion of the transitional epithelium of the bladder and the underlying blood vessels → hemorrhagic cystitis
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.
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 .
The information on Drugs for the Treatment of Hemorrhagic Cystitis is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and/or specialist before taking drugs for the treatment of haemorrhagic cystitis.
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.
Below are some of the drugs most used in therapy for the treatment of hemorrhagic cystitis, and some examples of pharmacological specialties. It is up to the doctor to choose the most suitable active ingredient and dosage for the patient based on the triggering cause, the severity of the disease and the patient’s response to the treatment.
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