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Intravesical Instillation of Dilute Formalin to Control Hemorrhagic Cystitis

Description

Infusion of a dilute formalin solution can control hemorrhagic cystitis but may be associated with life-threatening complications if not used properly. Alternative therapy is preferred but occasionally this is used when other therapies have failed or are not available.


 

The most important concern is to make sure that the correct concentration of formalin is used. 100% formalin is approximately 37% formaldehyde with methanol added as a stabilizer. The lowest possible percentage of formalin is recommended, often <= 4%.

 

Absorbed formalin is metabolized to formic acid, which can be toxic. Additives such as methanol may also be toxic if absorbed.

 

Complications:

(1) acute tubular necrosis, which can be fatal

(2) metabolic acidosis (due to the formic acid)

 

Risk factors for complications:

(1) high concentration of formalin

(2) reflux of the solution up the ureters

(3) high blood levels of formic acid

 


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