Penicillin G-induced hemorrhagic cystitis

No abstract available.

Metabólitos de óxido nítrico no interstício da medula espinhal lombossacral e no líquido cefalorraquidiano em ratas com cistite aguda induzida por ciclofosfamida: um estudo in vivo com microdiálise / Nitric oxide metabolites in the lumbosacral spinal cord interstice and cerebrospinal fluid in female rats with acute cyclophosphamide-induced cystitis: an in vivo microdialysis study

OBJETIVO: Determinar a concentração de nitrato/nitrito no líquido cefalorraquidiano e no interstício do corno dorsal entre L6-S1 da medula espinhal em ratas com ou sem cistite induzida por ciclofosfamida. MÉTODOS: Todos os experimentos foram conduzidos usando ratas Wistar. Um probe de microdiálise foi implantado no espaço subaracnoide ou no tecido da medula espinhal nos segmentos L6-S1 (confirmado histologicamente). Dois dias depois, o probe de microdiálise foi perfundido com líquido cefalorraquidiano artificial, contendo ou não NG-monometil-L-arginina. As amostras foram coletadas a cada 15 minutos e mantidas a -20ºC. As concentrações de nitrito/ nitrato foram determinadas por quimiluminescência. RESULTADOS: Nos animais normais, os valores médios das concentrações de nitrito/nitrato, na primeira amostra de microdialisado de líquido cefalorraquidiano e do interstício da medula espinhal, foram semelhantes (482,5±90,2pmol/75µL, n=20, e 505,7±11,5pmol/75µL, n=6, respectivamente), enquanto nas amostras de ratas com cistite, esses valores foram significativamente maiores (955,5±66,3pmol/75µL, n=8, e 926,5±131,7pmol/75µL, n=11, respectivamente). Em ambos os grupos, a NG-monometil-L- arginina causou uma significativa redução na concentração de nitrito/nitrato. Curiosamente, a redução máxima de concentração de nitrito/nitrato causada pela NG-monometil-L- arginina não foi maior que 30% dos valores iniciais. CONCLUSÕES: Esses resultados constituem a primeira demonstração de que as concentrações de nitrito/nitrato no líquido cefalorraquidiano e no interstício da medula espinhal estão elevadas entre 20 e 22 horas após a cistite induzida por ciclofosfamida, e indicando que a cistite está associada a alterações na produção de óxido nítrico, nos segmentos da medula espinhal, nos quais termina a maioria dos aferentes primários da bexiga.

OBJECTIVE: To determine the concentration of nitrate/nitrite in the cerebrospinal fluid and in the dorsal horn interstice of the L6-S1 spinal cord boundary in rats with or without cystitis induced by cyclophosphamide. METHODS: All experiments were conducted using Wistar female rats. A microdialysis probe was implanted in the subarachnoid space or in the spinal cord tissue at the L6-S1 segments (confirmed histologically). Two days later, the microdialysis probe was perfused with artificial cerebrospinal fluid, containing or not NG-monomethyl-L-arginine. Samples were collected every 15 minutes and kept at -20ºC. Nitrite/nitrate concentrations were determined by chemiluminescence. RESULTS: In normal animals, the mean values of nitrite/nitrate concentrations in the first microdialysate sample of the cerebrospinal fluid and of the spinal cord interstice were similar (482.5±90.2pmol/75µL, n=20, and 505.7±11.5pmol/75µL, n=6, respectively), whereas, in the samples from rats with cystitis, these values were significantly greater (955.5±66.3pmol/75µL, n=8, and 926.5±131.7pmol/75µL, n=11, respectively). In both groups, NG-monomethyl-L- arginine caused a significant reduction in the nitrite/nitrate concentration. Interestingly, the maximal reduction of nitrite/nitrate concentration caused by NG-monomethyl-L- arginine was no greater than 30% of the initial values. CONCLUSIONS: These results constitute the first demonstration that nitrite/nitrate concentrations in the cerebrospinal fluid and spinal cord interstice are elevated between 20- and 22 hours after cyclophosphamide-induced cystitis, and indicate that cystitis is associated with changes in the production of nitric oxide in the spinal cord segments, where most primary bladder afferents end.

Efeitos do extrato de Chenopodium ambrosioides L. na cistite induzida pela ciclofosfamida / Effects of Chenopodium ambrosioides L. extract on cyclophosphamide induced cystitis

A cistite hemorrágica (CH) consiste em um processo inflamatório difuso de origem infecciosa ou não que resulta em um sangramento da mucosa vesical. As CH crônicas recorrentes induzidas pela ciclofosfamida (CYP) são um desafio na prática clínica pela alta morbidade e por vezes mortalidade dos pacientes. O tratamento da CH induzida pela ciclofosfamida consiste no uso de MESNA, disulfiram, N-acetil-cisteína, anti-inflamatório, oxigênio hiperbárico, hiper-hidratação e irrigação vesical, mas novas terapias têm sido investigadas, inclusive usando produtos naturais. A espécie vegetal Chenopodium ambrosioides L., conhecida popularmente como mastruz, mastruço e erva-de-Santa-Maria, tem sido relatada pela população como anti-inflamatório e analgésico. O presente estudo investigou os efeitos do extrato bruto hidroalcoólico de folhas de Chenopodium ambrosioides na CH induzida pela ciclofosfamida em ratos. Vinte e nove ratos receberam 150 mg/kg de CYP por via intraperitoneal (i.p.) para indução de CH e em seguida foram divididos em três grupos: controle negativo (CN), tratados com soro fisiológico a 0,9%; extrato bruto hidroalcoólico de Chenopodium ambrosioides (EBHCa), tratado com dose única de 50 mg/kg de extrato bruto hidroalcoólico de Chenopodium ambrosioides (EBH) e controle positivo (CP), tratados com dose única de 15 mg/kg de diclofenaco de potássio, todos por gavagem. Após 48 horas da indução da CH os animais foram sacrificados para retirada da bexiga, que foi preparada para análise histopatológica e imuno-histoquímica. O EBH foi capaz de diminuir o peso da bexiga e histologicamente a inflamação aguda e crônica da bexiga, a extensão do infiltrado inflamatório na parede vesical e a neoformação capilar do mesmo modo que o diclofenaco de potássio, quando comparados ao grupo CN. Observou-se ainda uma redução da expressão imuno-histoquímica de cicloxigenase-2 (COX-2) e do fator nuclear kappa B (NFB) na bexiga. No presente estudo o EBH das folhas de Chenopodium...

Hemorrhagic cystitis (HC) consists of a diffuse inflammatory process that results on the bleeding of the bladder mucosa due to infectious or noninfectious etiology. Chronically recurrent CYP induced HC remains a challenge to clinical practice given its high morbidity and sometimes mortality of patients. Treatment consists of administering MESNA, disulfiram, N-acetylcysteine, anti-inflammatory, hyperbaric oxygen, hyperhydration and bladder irrigation, though new therapies have been investigated, such as the use of natural products. Popularly known as mastruz, mastruço and erva-de-Santa-Maria, Chenopodium ambrosioides L. has been generally reported by people as having anti-inflammatory and analgesic effects. The following study investigated the effects of a hydroalcoholic crude extract (EBH) of Chenopodium ambrosioides leaves on cyclophosphamide (CYP) induced HC in rats. In order to induce HC, twenty nine rats were intraperitoneally (i.p.) administered 150mg/kg of CYP and then divided into three groups: negative control (NC) were treated with 0,9% saline solution; hydroalcoholic crude extract of Chenopodium ambrosioides (EBHCa) were treated with a single dose of 50 mg/kg of EBH administered and positive control (PC) were treated with a single dose of 15 mg/kg of diclofenac potassium, all of them by gavage. After 48 hours of HC induction, all rats were sacrificed, their bladders removed and prepared for histopathological and immunohistochemical analysis. EBH was able to decrease bladder weight and histologically decrease acute and chronic bladder inflammation, decrease on the infiltrated inflammatory extension of the bladder wall and capillary neoformation in the same way of those from group CN. There was also a reduction in the immunohistochemical expression of cyclooxygenase-2 (COX-2) and nuclear factor kappa B (NFkB) in the bladder. In this study, Chenopodium ambrosioides leaves EBH showed anti-inflammatory activity which was similar to results...

Penicillin G-induced hemorrhagic cystitis: a case and review of the literature

No abstract available.

Protective effect of simvastatin in the cyclophosphamide-induced hemohrragic cystitis in rats / Efeito protetor da sinvastatina na cistite hemorrágica induzida pela ciclofosfamida em ratos

PURPOSE: Cyclophosphamide (CYP) is an antineoplastic agent used for the treatment of many neoplastic and inflammatory diseases. Hemorrhagic cystitis is a frequent side effect of CYP. Several studies show that simvastatin has important pleiotropic (anti-inflammatory and immunomodulatory) effects. The purpose of the study was to investigate the effect of simvastatin on bladder, ureter and kidney injury caused by CYP. METHODS: Adult male Wistar rats were randomly divided into three groups. The CYP/SIM group received simvastatin microemulsion by gavage during 7 days (10 mg/kg body wt) before the administration of CYP and the CYP/SAL group rats received saline 0.9 percent. The control rats were not treated. After that, all rats were treated with a single dose of CYP 200 mg/kg body wt intraperitoneally. The rats were killed 24 h after CYP administration. Plasma cytokines (TNF-α, IL-1β, IL-6) were measured by ELISA. Macro and light microscopic study was performed in the bladder, kidney and ureter. RESULTS: In the bladders of CYP/SIMV treated rats edema of lamina propria with epithelial and sub-epithelial hemorrhage were lower than in CYP/SAL treated rats. The scores for macroscopic and microscopic evaluation of bladder and ureter were significantly lower in CYP/SIMV rats than in CYP/SAL rats. The kidney was not affected. The expression of TNF-α, IL-1β and IL-6 was significatly lower in CF/SINV rats (164.8±22, 44.8±8 and 52.4±13) than in CF/SAL rats (378.5±66, 122.9±26 e 123.6±18), respectively. CONCLUSION: The results of the current study suggest that simvastatin pretreatment attenuated CYP-induced urotelium inflammation and decreased the activities of cytokines.

OBJETIVO: Ciclofosfamida (CF) é um agente antineoplásico frequente implicado na etiologia da cistite hemorrágica. Vários estudos mostram que a sinvastatina tem importantes efeitos pleiotrópicos (anti-inflamatórios e imunomoduladores). O objetivo do trabalho foi estudar os efeitos da sinvastatina na prevenção de cistite hemorrágica e lesões uroteliais induzidas por CF em modelo experimental. MÉTODOS: Doze ratos Wistar foram distribuídos de forma randomizada em três grupos: nos ratos do grupo experimental (CF/SINV), foi administrada microemulsão de sinvastatina 10mg/Kg, por via oral (gavagem), durante 7 dias antes da administração de CF e os ratos do grupo controle (CF/SAL), foram tratados com solução salina 0,9 por cento nas mesmas doses e prazos. O grupo controle não foi tratado. Todos os ratos foram tratados com CF 200mg/Kg intraperitonial (dose única) e 24 horas após foram sacrificados. Exame macro e microscópico foi feito na bexiga e os rins e ureteres foram avaliados microscopia. Foram realizadas dosagens plasmáticas de TNF-α, IL-1β, IL-6 (ELISA). RESULTADOS: O escore para avaliação macroscópica do dano à bexiga e o escore para avaliação do dano histológico na bexiga e nos ureteres mostraram-se significativamente menores no grupo CF/SINV em comparação ao grupo CF/SAL (p<0,05). Os rins não foram afetados. A expressão de TNF-α, IL-1β, IL-6 também foi significativamente menor (p<0,05) no grupo CF/SINV (164,8±22, 44,8±8 e 52,4±13) em comparação ao grupo CF/SAL (378,5±66, 122,9±26 e 123,6±18), respectivamente. CONCLUSÃO: O estudo demonstrou eficácia da sinvastatina na atenuação da cistite hemorrágica e lesão ureteral induzidas por CF em ratos Wistar, através da interferência nas citocinas plasmáticas e nas lesões uroteliais.

Hind limb ischemic preconditioning induces an anti-inflammatory response by remote organs in rats

Ischemic preconditioning (IPC), a strategy used to attenuate ischemia-reperfusion injury, consists of brief ischemic periods, each followed by reperfusion, prior to a sustained ischemic insult. The purpose of the present study was to evaluate the local and systemic anti-inflammatory effects of hind limb IPC in male Wistar rat (200-250 g) models of acute inflammation. IPC was induced with right hind limb ischemia for 10 min by placing an elastic rubber band tourniquet on the proximal part of the limb followed by 30 min of reperfusion. Groups (N = 6-8) were submitted to right or left paw edema (PE) with carrageenan (100 µg) or Dextran (200 µg), hemorrhagic cystitis with ifosfamide (200 mg/kg, ip) or gastric injury (GI) with indomethacin (20 mg/kg, vo). Controls received similar treatments, without IPC (Sham-IPC). PE is reported as variation of paw volume (mL), vesical edema (VE) as vesical wet weight (mg), vascular permeability (VP) with Evans blue extravasation (µg), GI with the gastric lesion index (GLI; total length of all erosions, mm), and neutrophil migration (NM) from myeloperoxidase activity. The statistical significance (P < 0.05) was determined by ANOVA, followed by the Tukey test. Carrageenan or Dextran-induced PE and VP in either paw were reduced by IPC (42-58.7 percent). IPC inhibited VE (38.8 percent) and VP (54 percent) in ifosfamide-induced hemorrhagic cystitis. GI and NM induced by indomethacin were inhibited by IPC (GLI: 90.3 percent; NM: 64 percent). This study shows for the first time that IPC produces local and systemic anti-inflammatory effects in models of acute inflammation other than ischemia-reperfusion injury.

Expressions of Uroplakins in the Mouse Urinary Bladder with Cyclophosphamide-Induced Cystitis

Even though uroplakins (UPs) are believed to serve a strong protective barrier against toxic materials, cyclophosphamide (CP) causes extensive cystitis. We investigated the expression of UPs in the urothelium in CP induced mouse cystitis. A total of 27 ICR female mice received a single intraperitoneal injection of 200 mg CP/kg. Nine CP-treated mice and 6 controls were sequentially killed at 12, 24, and 72 hr post injection. Extensive cystitis and an increased vesical weight were seen. These all peaked within 12 hr post injection and they tended to decrease thereafter. The level of all the UPs mRNA, the protein expressions of UP II and III on immunoblotting study, and the expression of UP III on immunolocalization study were maximally suppressed within 12 hr; this partially recovered at 24 hr, and this completely recovered at 72 hr post CP injection. In conclusion, CP reduced the expression of UPs. The reduction of the UPs mRNA and protein was time dependent, and this peaked within 12 hr after CP injection. However, the damage was rapidly repaired within 24 hr. This study demonstrates a dynamic process, an extensive reduction and rapid recovery, for the UPs expression of the mouse urinary bladder after CP injection.

Interleukin-11 attenuates ifosfamide-induced hemorrhagic cystitis

OBJECTIVE: To investigate the possible protective effect of recombinant human interleukin-11 (rhIL-11) against ifosfamide (IFS)-induced hemorrhagic cystitis (HC) MATERIALS AND METHODS: Male Swiss mice (20-30g) were pretreated with rhIL-11 (25-625 mg, subcutaneously.) 30 min before intraperitoneal injection of IFS (400 mg/kg) or with saline (control group). Twelve hours later, HC was evaluated by bladder wet weight (BWW) to quantify edema, Evans blue extravasation (EBE) to measure vascular permeability, and macroscopic and microscopic analysis. All bladders were assessed by histopathological analysis RESULTS: rhIL-11 (at 125 and 625 mg) attenuated the IFS- induced increase of BWW (37.48 percent and 45.44 percent, respectively, p < 0.05) and EBE (62.35 percent and 56.47 percent, respectively, p < 0.05). IFS- induced macroscopic edema and hemorrhage and microscopic alterations, were also prevented by rhIL-11 at 625 mg. (p < 0.05) CONCLUSION: Our results demonstrate a protective effect of rhIL-11 on experimental IFS- induced HC, not previously reported.

A model of hemorrhagic cystitis induced with acrolein in mice

Acrolein is a urinary metabolite of cyclophosphamide and ifosfamide, which has been reported to be the causative agent of hemorrhagic cystitis induced by these compounds. A direct cytotoxic effect of acrolein, however, has not yet been demonstrated. In the present study, the effects of intravesical injection of acrolein and mesna, the classical acrolein chemical inhibitor, were evaluated. Male Swiss mice weighing 25 to 35 g (N = 6 per group) received saline or acrolein (25, 75, 225 æg) intravesically 3, 6, 12, and 24 h before sacrifice for evaluation of bladder wet weight, macroscopic and histopathological changes by Gray's criteria, and 3 and 24 h for assessment of increase in vascular permeability. In other animals, mesna was administered intravesically (2 mg) or systemically (80 mg/kg) 1 h before acrolein. Intravesical administration of acrolein induced a dose- and time-dependent increase in vascular permeability and bladder wet weight (within 3 h: 2.2- and 21-fold increases in bladder wet weight and Evans blue dye exuded, respectively, at doses of 75 æg/bladder), as confirmed by Gray's criteria. Pretreatment with mesna (2-mercaptoethanesulfonic acid), which interacts with acrolein resulting in an inactive compound, inhibited all changes induced by acrolein. Our results are the first demonstration that intravesical administration of acrolein induces hemorrhagic cystitis. This model of acrolein-induced hemorrhagic cystitis in mice may be an important tool for the evaluation of the mechanism by which acrolein induces bladder lesion, as well as for investigation of new uroprotective drugs.

Comparison of uroprotective efficacy of mesna and amifostine in Cyclophosphamide- induced hemorrhagic cystitis in rats.

BACKGROUND: Hemorrhagic cystitis (HC) is a dose limiting side effect of cyclophosphamide (CYP). AIM: In this study, we aimed to investigate the role of amifostine in the protection of CYP-induced HC and compare its efficacy with mesna. SETTING AND DESIGN: This animal study was conducted in the Experimental Animals Breeding and Research Center of the Medical Faculty of Uludag University. MATERIALS AND METHODS: Male Wistar rats (150-200 g; 10 rats per group) were randomly assigned to four groups. Group I (control group) received no drugs, group II received CYP (200 mg/kg, i.p.) alone, group III received amifostine (200 mg/kg, i.p.) and CYP, and group IV received CYP and mesna (40 mg/kg, i.p.) immediately and 4 and 8 h after administration of CYP. Bladders of animals were assessed macroscopically and histologically 24 h later. Gross assessment for presence of edema and hemorrhage and histological evaluation of damage to the bladder were scored according to Gray's criteria. STATISTICAL ANALYSIS USED: For macroscopic and microscopic data, we used statistical evaluation by Kruskal-Wallis nonparametric analysis of variance followed by the Mann-Whitney U-test. RESULTS: All the animals in group II had evidence of HC. Significant histological damage and macroscopic changes were present in this group compared to control group (P<0.001). The median scores for bladder damage in group III and IV were significantly lower compared to group II (P<0.001). When the median scores for bladder damage of group I, III, and IV were compared, there was no significant difference among these groups. CONCLUSION: This study demonstrated the efficacy of amifostine in prevention of cyclophosphamide-induced hemorrhagic cystitis.

Hemorrhagic Cystitis due to Intravesical Instillation of Gentian Violet Completely Recovered with Conservative Therapy

Chemical cystitis due to intravesical instillation of gentian violet or crystal violet is rare and all of the reported cases have been in adults using undiluted solution, which resulted in long-term sequelae. This is a case report on a 16-month-old boy with hemorrhagic cystitis after the instillation of diluted gentian violet into the bladder to rule out bladder injury during inguinal herniorrhaphy. Although he was completely recovered with conservative therapy, gentian violet, even when diluted, should not be used on the urinary tract.

Pharmacological and histopathological study of cyclophosphamide-induced hemorrhagic cystitis - comparison of the effects of dexamethasone and Mesna

Chemotherapy with oxazaphosphorines, such as cyclophosphamide (CYP), is often limited by unacceptable urotoxicity. Without uroprotection, hemorrhagic cystitis (HC) becomes dose-limiting. To compare the uroprotective efficacy of classical 2-mercaptoethanesulfonic acid (Mesna) treatment with dexamethasone in CYP-induced HC, male Wistar rats (150-200 g; N = 6 in each group) were treated with saline or Mesna (40 mg/kg, ip) immediately and 4 and 8 h after ip administration of CYP (200 mg/kg). One, 2 or 3 doses of Mesna were replaced with dexamethasone (1 mg/kg, ip). The animals were sacrificed 24 h later. Cystitis was evaluated by determining the changes in bladder wet weight (BWW) and by macroscopic and microscopic analysis. CYP treatment induced a marked increased in BWW 162 percent 0.05, which was significantly inhibited by treatment with 3 doses of Mesna 0.05; 80 percent. The replacement of 1 or 2 doses of Mesna with dexamethasone reduced the increase in BWW by 83.3 and 95 percent, respectively. Macroscopic analysis of the bladder of rats with CYP-induced HC showed severe edema and hemorrhage, confirmed by microscopic analysis, that also showed mucosal erosion, inflammatory cell infiltration and ulcerations. The replacement of 1 or 2 doses of Mesna with dexamethasone inhibited the CYP-induced increase in BWW and almost abolished the macroscopic and microscopic alterations, with no significant difference between the effects of Mesna and dexamethasone, indicating that both drugs were efficient in blocking HC. However, although the replacement of all Mesna doses with dexamethasone reduced the edema, it did not prevent HC, suggesting that Mesna is necessary for the initial uroprotection

Participation of TNF-Ó and IL-1 in the pathogenesis of cyclophosphamide-induced hemorrhagic cystitis

The involvement of cytokines TNF-Ó and IL-1 has been investigated in a model of cyclophosphamide (CYP) - induced hemorrhagic cystitis. Male Swiss mice (25-30 g) received CYP in a single ip dose of 100, 200 or 400 mg/kg and were sacrificed 6, 12, 24, 48 and 72 h later. Cystitis was evaluated by determining the changes in bladder wet weight (BW) and plasma protein extravasation (PPE, measured by the Evans blue leakage technique). CYP treatment induced a marked increase in BW and in PPE, which was significant within 6 h and reached maximal values within 12 h (BW, 118 percent, P<0.05; N = 11; and PPE, 824 percent, P<0.05; N = 11), continuing to be significant until 48 h. Pretreatment of animals with whole anti-TNF-Ó serum (25 or 50 µl diluted in 500 µl 0.9 percent saline, ip, 30 min earlier caused a significant reduction in the CYP-induced BW increase in 6-h and 12-h cystitis (82 percent and 91 percent, respectively, P<0.05; N = 6) and...

Cistitis hemorrágica masiva por ciclofosfamida y su tratamiento con formalina: experiencia en niños / Massive hemorrhagic cystitis due to ciclosphosphamide and its treatment with formalin: experience in children

En los últimos diez años, tres niños con cuadros oncológicos en tratamiento quimioterápico, que incluía ciclosfosfamida, presentaron hematuria masiva con anemia severa, resistente a tratamiento generales y locales, su gravedad llegó a plantear la cistectomía radical. La instilación intravesical de formalina al 2 por ciento detuvo las hemorragias

Cistitis crónica hemorrágica por ciclofosfamida en dermatomiositis refractaria a tratamiento esteroidal / Chronic hemorrhagic cystitis induced by cyclophosphamide in dermatomyositis refractory to corticosteroid treatment

Se describe el caso de una niña de 14 años que a la edad de 7 años consultó por debilidad muscular de grupos proximales y compromiso cutáneo característico de dermatomiositis, confirmada con concentraciones altas de creatinfosfokinasa sérica y alteraciones características en la electromiografía y biopsia muscular. Debido a falta de respuesta a dosis altas de prednisona se le dio ciclofosfamida oral 0,8 mg.kg.día (25 mg.m*), que debió suspenderse a las dieciséis semanas por cistitis hemorrágica, cambiándose el tratamiento a azatioprina por 2 años, después de lo cual hubo remisión completa de la enfermedad. Fue estudiada a los 13 años por hematuria microscópica persistente, demostrándose cistitis crónica mediante cistoscopía y biopsia vesical. Se destaca la presencia de esta complicación con dosis y tiempo total de tratamiento menores a los descritos en la literatura

Eosinophilic cystitis associated with long-term use of perphenazine

We report a case of eosinophilic cystitis in a person who has been taking Perphenazine [Trilafon] for more than twelve years for a psychiatric disorder. Etiology, pathology and treatment of this rare disorder is discussed. To our knowledge no such association has been reported here to fore

Cistite hemorrágica induzida por ciclo-fosfamida na nefrite lúpica: relato de caso / Hemorrhagic cystitis induced by cyclophosphamide in lupus nephritis: report of a case

Os autores descrevem o caso de uma paciente de 20 anos, portadora de nefrite lúpica, que desenvolveu quadro de cistite hemorrágica após uso oral de ciclofosfamida por seis meses, na dose de 100mg/dia. A paciente apresentou-se com hematúria macroscópica e dor abdominal importante; a cistoscopia revelou sangramento difuso e ulceraçöes de epitélio vesical. Tratamento conservador, com irrigaçäo vesical contínua com sulfato de alumínio, mostrou-se insuficiente, por causa da constante obstruçäo da sonda de Folley. Analgesia epidural com morfina permitiu manipulaçäo eficaz da sondagem vesical e o sangramento desapareceu completamente em cinco dias. Os autores discutem as causas da hematúria e os outros tratamentos utilizados nestes casos