Hemorrhagic cystitis

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 11 May 2016, last major update May 2015

Copyright: (c) 2003-2016,, Inc.

PubMed Search: hemorrhagic cystitis
Cite this page: Hemorrhagic cystitis. website. Accessed May 25th, 2018.
Definition / general
  • 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)
Clinical features
  • Irritative voiding symptoms, gross hematuria
Case reports
  • 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

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Inflammatory bleeding bladder mucosa

Gross images

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Hemorrhagic and ulcerative cystitis after cyclophosphamide

Microscopic (histologic) images

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Edema, bleeding and granulocyte infiltration

Hemorrhage and edema in the lamina propria

Cytology images

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Case of the Week #353:

47 year old man with herpes viral cytopathic effects in urine cytology

Differential diagnosis
  • Hemorrhage associated with malignancy