Palliative Treatment of Intractable Hematuria in Context of Advanced Bladder Cancer: A Systematic Review

Abstract

<p><strong>Introduction:</strong> In a patient with bladder urothelial cancer that is not suitable for or does not choose curative treatment, intractable hematuria is a disastrous condition. In this article, we tried to review the literature and extract a stepwise approach for palliative treatment of hematuria in these patients.</p><p><strong>Materials and Methods: </strong>The MEDLINE was searched with the help of the Medical Subject Headings system using different combinations of terms <em>urinary bladder neoplasm</em>, <em>hematuria</em>, <em>carboprost</em>,<em> cyclophosphamide</em>, <em>cystitis</em>, <em>alum</em>, and <em>hyperbaric oxygenation</em>. The articles were separately reviewed by the two authors and verified by each other. Eventually, a decision tree was developed for management of gross hematuria in patients with bladder cancer.</p><p><strong>Results:</strong> Although, there was not any reported randomized controlled trial or prospectively designed study, the available case series were rather expressive to draw out a logical approach. Formalin has a grave adverse effect profile and recommended only in special circumstances. For management of each case of gross hematuria in bladder cancer, the etiology of bleeding is the most important determinant.</p><p><strong>Conclusion:</strong> Hematuria in the context of advanced bladder neoplasms can now be effectively treated with fewer side effects using all available modalities in a logical holistic approach. We proposed a decision tree for management of hematuria in this context. However, regarding lack of well-designed trials, a treatment method should be based on individualized scenarios and clinical experience, bringing into account the patient’s preferences.</p>