The management of intractable haematuria

Intractable haematuria from the bladder can be lifethreatening and its management remains a dif®cult clinical problem. Severe bleeding can arise as a result of radiation cystitis, bladder carcinoma, cyclophosphamideinduced cystitis and severe infection. When irrigation of the bladder through a three-way catheter and fulguration of the bleeding lesions fail to stop the haematuria, a life-threatening situation can develop, when blood transfusion fails to keep pace with the rate of blood loss. Patients with massive uncontrollable haematuria are often elderly and un®t for cystectomy as a treatment. Many urologists have had to manage this dif®cult problem, and several different treatments have been attempted and described, with varying degrees of success. This aims of the review are to describe the methodology of different treatments so that the reader can readily reproduce a described method, and to review their ef®cacy and their morbidity.