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Hemorrhagic cystitis

Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 24 April 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.


● Clinical syndrome of gross hematuria, often with irritative bladder symptoms


● Due to drug treatment (cyclophosphamide, methotrexate, ifosphamide), radiation therapy (eMedicine), viral infection (adenovirus, herpes simplex virus, CMV, BK virus)
● Post allogeneic hematopoietic stem cell transplantation (Chin Med J (Engl) 2008;121:1766)
● Occurs in 10% of pediatric bone marrow transplants (J Pediatr Urol 2009;5:254)


● Irritative voiding symptoms, gross hematuria

Case reports

● 8 year old with BK-virus associated hemorrhagic cystitis presenting as mural nodules (Pediatr Radiol 2010;40:1430)
● 49 year old man with symptoms after receiving penicillin for endocarditis (Intern Med 2009;48:1667)
● 70 year old man with hemorrhagic cystitis due to melphalan (Case Report Med 2010;2010:569138)


● Clot evacuation and hydration, bladder irrigation with saline or alkalinized saline, intravesical instillation of aluminium hydroxide/magnesium hydroxide
● More aggressive therapies include transurethral coagulation of bladder, fixation with silver nitrate and formalin, embolization of internal iliac arteries or their branches to the bladder; rarely requires cystectomy

Clinical images

Intraoperative photograph shows inflammatory bleeding bladder mucosa

Gross images

Hemorrhagic and edematous cystitis

Urothelial carcinoma with marked hemorrhagic and edematous cystitis

Hemorrhagic cystitis: hypertrophied bladder due to carcinoma of prostate. Severe hemorrhagic cystitis bordering on gangrenous cystitis with hemorrhagic pyelitis and probably dilated ureters

Hemorrhagic cystitis with fiery red mucosa, due to Citrobacter cultured repeatedly during life

Hemorrhagic cystitis

Hemorrhagic and ulcerative cystitis after cyclophosphamide

Micro images

Edema, bleeding and granulocyte infiltration

Hemorrhage and edema in the lamina propria

Differential diagnosis

● Hemorrhage associated with malignancy

End of Bladder > Cystitis > Hemorrhagic cystitis

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