Hemorrhagic cystitis

[Mackey]

For those of you with experience caring for / treating post BMT patients
for hemorrhagic cystitis: what therapies have you found to be helpful?
We have a patient in our unit, who underwent auto BMT for Hodgkins. Our
average protocol concurrently administers Mesna with Cytoxan to help
prevent hem. cystitis. However, this patient had a previous reaction to
Mesna, and was not given the drug. We did perform CBI immediately prior
and throughtout Cytoxan administration. The foley was removed and abou
2-3 weeks after, the patient developed hemorrhagic cystitis. We have
attempted CBI with both NS and sterile water, clot evacuations, Alum
irrigations, Amicar drips, Carboprost instillations and currently, the
bleeding has improved - but echo shows a clot remains that fills the
bladder. Have you used anything different for your patients that has
worked? Any replies would be appreciated. Thanks in advance.