The Practical Management of Intractable Haematuria Within the National Health Service of the United Kingdom: A Literature Review.

The aim of this article is to provide an updated review of the practical management of intractable haematuria in the National Health Service (NHS) of the United Kingdom (UK). A literature search was performed using the PubMed Advanced Search Builder. The terms 'Intractable Haematuria' OR 'Haemorrhagic Cystitis' OR 'Radiation Cystitis' were entered in a joint search as terms in a given publication's title only. This generated 295 papers in total, which were manually screened for suitability. There were no specific inclusion or exclusion criteria. We liaised with senior pharmacists in our Medicine Information department to assess product availability. Based on the best available evidence, we propose a new treatment escalation plan for the management of intractable haematuria based on the safety profile and product availability in the UK. After initial management, first-line treatment could include intravesical hyaluronic acid, tranexamic acid, carboprost, adrenaline, or PuraStat®. Second-line treatment could include hyperbaric oxygen therapy or super selective embolisation. Percutaneous diversion and cystectomy represent last resorts. Not all proposed options for the management of intractable haematuria published in the literature are of practical use in the UK, and each has its own merits and disadvantages. The evidence base for the majority of treatment modalities recommended in the literature is overall weak, with a lack of appropriate randomised controlled trials to support their use. More research is required on available treatments and potentially novel treatments in order to drive a robust national census to serve the often morbid patient cohort presenting with intractable haematuria in the UK.