Technique used for PuraStat® application in urinary bladder bleeding

Authors

  • Petre Cristian Ilie Urology Department, The Queen Elizabeth Hospital King’s Lynn, UK
  • Hashem Darwazeh Urology Department, The Queen Elizabeth Hospital King’s Lynn, UK
  • Lara Hemsworth Urology Department, The Queen Elizabeth Hospital King’s Lynn, UK
  • Lee Smith Centre for Health Performance and Wellbeing, Anglia Ruskin University, UK

Keywords:

Hemorrhagic cystitis, haemostatic, PuraStat®, air cystoscopy

Abstract

Objectives: Persistent bleeding of the bladder is one of the side effects of radiotherapy. At present, there is no treatment to reliably cure the persistent bleeding caused by the radiation cystitis. PuraStat® (a haemostatic agent) has been successfully used to stop bleeding during endoscopy, and to control rectal bleeding after radiotherapy (post-radiation proctitis). We aimed to develop and describe the technique of using the PuraStat® for radiation cystitis.

Methods: For this procedure, we use a single use cystoscope. After assessment of bleeding using cystoscopy grading (TABS – score), a 50 mls (luer-lock) syringe is attached to the cystoscope, urine is aspirated. A three-way adaptor is placed on the flexible cystoscope fluid channel and air is instilled into the bladder, approximately 150 mls with the exact quantity depending on the bladder capacity. Next, an air cystoscopy is performed. Over the bleeding areas, a small amount of PuraStat® is applied by connecting the PuraStat® syringe to the flexible cystoscope and injecting it through the irrigation port. The same procedure is repeated approximately one month after the initial procedure. After another month, a further cystoscopy can be performed to assess clinical outcomes.

Findings: The technique was feasible to perform and is easy to duplicate. In our previous published case report on this novel technique, the results were promising with the bleeding stopped completely after the second application of PuraStat®.

Conclusions: The application of PuraStat® in the bladder is feasible, and in our single case experience, very effective. More cases are now needed to be able to assess the true effectiveness, and whether any adverse events may occur subsequently.

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References

Browne C, Davis NF, Mac Craith E, et al. A narrative review on the pathophysiology and management for radiation cystitis. Adv Urol. 2015;346812.

3-D Matrix. [Internet]. Purastat. [cited 26.11.2023]. Available from: https://3dmatrix.com/products/purastat

White K, Henson CC. Endoscopically delivered Purastat for the treatment of severe haemorrhagic radiation proctopathy: a service evaluation of a new endoscopic treatment for a challenging condition Frontline Gastroenterology 2021;12:608-613.

Martinez DR, Ercole CE, Lopez JG, et al. A novel approach for the treatment of radiation-induced hemorrhagic cystitis with the GreenLight™ XPS Laser. Int Braz J Urol. 2015;41:584-587.

Subramaniam S, Kandiah K, Chedgy F, et al. A novel self-assembling peptide for hemostasis during endoscopic submucosal dissection: a randomized controlled trial. Endoscopy. 2021;53(1):27-35.

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Published

2023-11-26

How to Cite

Ilie, P. C., Darwazeh, H., Hemsworth, L., & Smith, L. (2023). Technique used for PuraStat® application in urinary bladder bleeding. Atena Journal of Urology , 3, 1. Retrieved from https://atenajournals.com/index.php/aju/article/view/82

Issue

Vol. 3 (2023)

Section

Articles

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