Other agents for irrigation have included alum and prostaglandins. For more intractable bleeding it has been important to anesthetize the patients and remove all clots cystoscopically. This has usually been followed by chemical irrigations with the above substances and also phenol or formalin, now rarely used. Life-threatening bleeding requires heroic measures including hyperbaric therapy, percutaneous nephrostomy, vesicostomy or even total urinary diversion. The most important aspect of blocking side effects from cyclophosphamide is maximum hydration of the patient.
Hydration has the potential to decrease or prevent side effects.
Mesna is the drug most commonly used with hydration and binds to acrolein, reducing the harmful effects without affecting the chemotherapeutic potential. Before Mesna, Mucomyst was used but was abandoned because it reduced the effectiveness of cyclophosphamide. The protective effects of certain fruits and vegetables against cyclophosphamide toxicity has been known for some time and the report in this issue of Investigative Urology on prevention of HC with glucose-mannose binding plant lectins falls into that category. I have been disappointed that Mesna does not always provide protection to the bladder. Reports such as this offer encouragement.