Hemorrhagic cystitis: a review of management strategies and emerging treatments.

Hemorrhagic cystitis (HC) is characterized by persistent hematuria and lower urinary tract symptoms following radiation or chemotherapy. Its pathogenesis is poorly understood but thought to be related to acrolein toxicity following chemotherapy or fibrosis/vascular remodeling after radiation. There is no standard of care for patients with HC, though existing strategies including fulguration, hyperbaric oxygen therapy, botulinum toxin A, and other intravesical therapies have demonstrated short-term efficacy in cohort studies. Novel agents including liposomal tacrolimus are promising targets for further research. This review summarizes the incidence and pathogenesis of HC as well as current evidence supporting its different management strategies.