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Montgomery BD, Boorjian SA, Ziegelmann MJ, et al. Intravesical silver nitrate for refractory hemorrhagic cystitis. Turk J Urol. 2016;42(3):197-201doi: 10.5152/tud.2016.38445.
Montgomery, B. D., Boorjian, S. A., Ziegelmann, M. J., Joyce, D. D., & Linder, B. J. (2016). Intravesical silver nitrate for refractory hemorrhagic cystitis. Turkish journal of urology, 42(3), 197-201. https://doi.org/10.5152/tud.2016.38445
Montgomery, Brian D, et al. "Intravesical silver nitrate for refractory hemorrhagic cystitis." Turkish journal of urology vol. 42,3 (2016): 197-201. doi: https://doi.org/10.5152/tud.2016.38445
Montgomery BD, Boorjian SA, Ziegelmann MJ, Joyce DD, Linder BJ. Intravesical silver nitrate for refractory hemorrhagic cystitis. Turk J Urol. 2016 Sep;42(3):197-201. doi: 10.5152/tud.2016.38445. PMID: 27635296; PMCID: PMC5012448.
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Turk J Urol. 2016 Sep;42(3):197-201. doi: 10.5152/tud.2016.38445.

Intravesical silver nitrate for refractory hemorrhagic cystitis.

Turkish journal of urology

Brian D Montgomery, Stephen A Boorjian, Matthew J Ziegelmann, Daniel D Joyce, Brian J Linder

Affiliations

  1. Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 27635296 PMCID: PMC5012448 DOI: 10.5152/tud.2016.38445

Abstract

OBJECTIVE: 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.

MATERIAL AND METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Keywords: Bladder; hematuria; hemorrhagic cystitis; intravesical; silver nitrate

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