Hemorrhagic Cystitis
Bladder bleeding in women arising from radiation, chemotherapy, or immune triggers, causing significant morbidity and often misdiagnosed as recurrent UTI.
Overview
Hemorrhagic Cystitis presents as gross haematuria with bladder inflammation from non-infectious causes — most commonly cyclophosphamide chemotherapy, BCG immunotherapy, or pelvic radiation. Acrolein, a toxic metabolite of cyclophosphamide, directly damages the urothelium. Severity ranges from microscopic haematuria to life-threatening clot retention.
Key Symptoms
- Gross haematuria — frank blood in urine
- Urinary urgency and frequency
- Bladder clot formation and retention (severe cases)
- Suprapubic pain
- Anaemia from chronic blood loss
Pathophysiology
Acrolein from cyclophosphamide or radiation-induced ischaemia damages the GAG layer and urothelium directly, causing mucosal ulceration and haemorrhage. The defective barrier allows secondary inflammation to compound the injury.
Treatment Approach
Hydration, bladder irrigation, MESNA (for cyclophosphamide prevention), intravesical PPS or hyaluronic acid, and escalation to aluminium sulphate instillation, embolisation, or cystectomy in severe refractory cases.