Cystoscopic Application of PuraStat® in the Treatment of Radiation Induced Hemorrhagic Cystitis

Treatment of pelvic neoplasms with radiotherapy may develop long term side-effects such as recurrent hemorrhagic radiation cystitis (RHC). A 73-year-old male patient was admitted to a hospital emergency unit several times with gross hematuria leading to urinary clot retention and was diagnosed with RHC. During the last admission, the urinary bladder was catheterized, unobstructed, and maintained in continuous three- way saline irrigation. During hospitalization, the patient underwent a cystoscopic procedure for urinary bladder evaluation, clot evacuation, bladder biopsies and burning cauterization. Whole blood transfusions were required, and sodium hyaluronate (Cystistat®) bladder instillations were tried. None of these interventions led to clinical resolution. As the patient condition was deteriorating, cystoscopic application of Purastat® 3ml was administered which led to the remission of the urinary bleeding in the short term. We continue to monitor the effects in the medium and long term. Based on the current data, Purastat® haemostatic agent therapy may be considered for RHC, when conventional treatments are not effective or possible, potentially avoiding more aggressive interventions such as cystectomy