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Background: Urinary bladder tamponade is a urological emergency that is part of the clinical routine of every urologist and requires immediate and adequate diagnosis and therapy., Objectives: Presentation of the clinical picture of urinary bladder tamponade including etiology, diagnostics, and therapy as well as formulation of recommendations for action for clinical routine., Materials and Methods: Structured presentation of the diagnosis and therapy of urinary bladder tamponade with practical recommendations for action based on a current literature search and a clinical case study., Results: Urinary bladder tamponade is a usually painful filling of the urinary bladder with blood clots as part of gross hematuria. The central pillars of diagnostics are anamnesis, targeted physical examination, and sonography. Therapy involves the rapid insertion of a flushing catheter with manual evacuation of the tamponade. A flushing catheter with at least 20 French should be used here., Conclusion: Timely diagnosis and prompt treatment are crucial. This usually includes transurethral catheter insertion with manual evacuation. If the tamponade is unsuccessfully removed, further measures such as endoscopic evacuation or, as a last resort, sectio alta or radical cystectomy are available., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Microscopic hematuria that is not explained by an obvious underlying condition is a frequent and often an incidental finding that commonly triggers urological or nephrological evaluation. Potential underlying conditions range from benign to severe malignant diseases of the kidneys and urinary tract., Materials and Methods: A nonsystematic literature search was performed, focusing on potential urological and nephrological causes of hematuria. National and international guidelines were considered and diagnostic as well as follow-up strategies are discussed. We provide a recommendation for practices in the clinical evaluation of hematuria., Results: The overall prevalence for microscopic hematuria is estimated at approximately 2%, whereas risk populations show an increase to around 30%. In 13-35% of patients presenting with microscopic hematuria, a medical or surgical intervention is required. Malignant tumors of the kidneys or urinary tract can be diagnosed in 2.6-4% of all patients and in up to 25.8% of at-risk populations. "Idiopathic microscopic hematuria" without an obvious underlying medical condition accounts for approximately 80% of patients with asymptomatic hematuria. After exclusion of nephrological diseases, standard diagnostic procedures by means of medical history, physical and laboratory examination as well as ultrasound of the kidneys and the urinary tract should be performed. In the presence of risk factors, an extended diagnostic work-up using cystoscopy, urinary cytology, and cross-sectional imaging of the upper urinary tract is indicated., Conclusion: Evidence-based strategies of a risk-adapted diagnostic evaluation for microscopic hematuria are not available. The development of reliable clinical and molecular markers offers great potential for the identification of patients at higher risk for harboring severe diseases.

Urethritis posterior is a possible cause of asymptomatic haematuria in prepubescent boys. It is a benign lesion of the posterior urethra and its cardinal symptoms are blood spots in the underwear without any laboratory or radiologic findings. Urethrocystoscopy is the only way to confirm the diagnosis, but has been subject to criticism as it is associated with a high risk of strictures. It is advisable to adopt a "wait and see" strategy because urethritis posterior usually heals spontaneously over time. This condition is most likely caused by detrusor-sphincter dyssynergia, since behavioural intervention with biofeedback therapy offers good treatment results., (© Georg Thieme Verlag KG Stuttgart · New York.)

A 2-year-old male castrated German Shepherd dog mix was presented with chronic macroscopic haematuria. Further diagnostics included abdominal ultrasound and urethrocystoscopy and led to a diagnosis of severe bilateral idiopathic renal haematuria (IRH). Medical treatment with Yunnan Baiyao was unsuccessful. Bilateral renal-sparing sclerotherapy was performed and, despite distal migration of both ureteral stents within 12 days, permanently resolved the macroscopic haematuria.

Adequate and successful treatment of Hb-relevant macrohaematuria in bladder cancer patients is a frequent problem in clinical routine. It is often not easy to identify a good treatment option for inoperable older patients. A possible option is transcatheter-based arterial embolisation of the vesical artery. Unfortunately there are only few publications about this procedure; a detailed analysis of bladder embolisation is difficult to find in the literature. Our report illustrates the embolisation of the vesical artery in an 84-year-old patient with bladder cancer with an Hb-relevant, transurethral non-curable macrohaematuria. Massive necrosis of the M. gluteus maximus developed after embolisation of the vesical artery. During the ensuing surgery, the entire musculature of the gluteal region was removed, and the N. ischiadicus was cut. The patient was supervised first in the intensive care and then in the palliative care ward. The patient's prognosis is unfavourable due to the localisation and size of the wound and consecutive life-long immobility. Embolisation of the vesical artery is a viable procedure, but only if alternative therapeutic strategies are impossible. It should only be performed by an experienced radiologist and it is strongly recommended not to apply liquid embolisation agents. Inadequate embolisation of the vesical artery can lead to extensive necrosis. Radiological diagnostics help to identify the margins of the necrotic region. During the intervention, maximum attention should be paid to saving the entirety of N. ischiadicus, especially in patients with large necrotic areas., (© Georg Thieme Verlag KG Stuttgart · New York.)

History and Admission Findings: We report on the case of a young women presenting with macrohaematuria, petechiae and strong headaches., Investigations: Laboratory showed a thrombotic microangiopathy with helmet cells, increased LDH levels (>600 U/l), and thrombocytopenia (<40,000/μl)., Diagnosis, Treatment and Course: Due to strong haemolytic activity and headache with blurred vision, immediate plasma separation with fresh frozen plasma was commenced. Markedly decreased ADAMTS13 activity and detection of anti-ADAMTS13 antibodies were consistent with the diagnosis of idiopathic thrombotic thrombocytopenic purpura. In total, 11 plasma separations were required to stop disease activity. In parallel, immunosuppressive therapy using glucocorticoids was initiated. The patient was discharged from the hospital in a good general condition and with normalized laboratory findings 26 days after hospitalization., Conclusions: All patients with anemia and thrombocytopenia should be tested for haemolysis and helmet cells. An early diagnosis and initiation of necessary therapy are determining for the clinical outcome., (© Georg Thieme Verlag KG Stuttgart · New York.)

Colic attacks by a foreign body in the urinary tract are very rare and mostly follow iatrogenic manipulation. This case report focuses on ureteric colic thought to result from radiological embolisation material. It is of practical interest because embolisation of prolonged bleeding after endourological procedures is widely done.An 80-year-old woman with a long history of nephrolithiasis underwent percutaneous nephrolithotomy. She suffered from a continuous, transfusion-obligatory bleeding. The source of bleeding was treated with embolisation by coiling. About 2 years later, the patient presented with persistent pain on the right abdominal side and urinary obstruction. A dislocation of the coils into the ureteropelvic junction was diagnosed. After primary ureteral stenting, the foreign body was removed via ureterotomy.

By means of a case report on a 44-year-old female patient, we show how, with changing personnel and places of care, decisions as well as the kind of decision-making during illness influence the quality of care. The patient was receiving immunosuppressive therapy after kidney transplantation and then suffered from a carcinomatous ovary. At first she refused postoperative chemotherapy, but then returned with a very advanced state of metastatic growth. The lack of continuity, a missing overall interdisciplinary concept of medical case, as well as the failure to document decision processes and the patient's attitude to life and suffering made it difficult for the caring team to accompany her in the last weeks of life. A possible solution to such a complex problem will be the introduction of ethical case deliberation.

Objective: Renal embolisation offers a minimal invasive means of renal ablation under primary palliative indication. We evaluated our experience with this technique in a series of 40 patients., Patients and Methods: From 1996 to 2002 a total of 40 patients underwent total embolisation of the kidney. Our patients encompassed 15 females and 25-males (median age: 68 years, 46 - 89 years). In 15 patients indication for embolisation was to ablate a non-functioning kidney following obstruction due to advanced cancer, in 9 patients preoperatively with advanced renal cell carcinomas invading the vena cava, in 8 patients for control of hematuria and in 8 patients with non-operable advanced renal cancers. The embolisation was carried out in DAS-technique with a 7 Fr. selective catheter and central placement of macrocoils, from 2000 on we additionally performed a peripheral embolisation with polyvinylalcohol (PVA) particles. The intervention took place in epidural anesthesia., Results: Perioperatively in all patients a complete occlusion of the renal artery as well as acessory arteries (n = 6) could be documented radiographically, perioperative complications were not observed. A post-embolisation syndrome occured in 32 patients. Reinterventions with repeat embolisation became necessary in 5 patients (persistent urine production-n = 4, persistent hematuria-n = 1)., Summary: The combined central and peripheral embolisation of the kidney in epidural anesthesia is a valuable means in selected patients under palliative indication for defunctionalisation of the kidney as well as control of hematuria.

A ruptured lumbar artery is an uncommon lesion for a retroperitoneal hematoma. This report describes a 77-year-old man with bladder carcinoma who developed a spontaneous retroperitoneal hemorrhage during anticoagulation therapy for an artificial cardiac valve. The diagnosis was suggested by computed tomography scan and confirmed with angiography. Successful treatment consisted of occluding bleeding arteries by transcatheter embolization.

The symptom complex of frequency and urgency with or without urge incontinence is termed overactive bladder (OAB) according to the new definition by the International Continence Society. The background for this change in definition is the great economic and social importance of the disease, the rising costs in medicine, and the tendency to develop the simplest possible therapeutic strategies. Therapy consists of the administration of an anticholinergic/spasmolytic drug for at least 3 months. Although a great percentage of patients with OAB can be clinically identified, the required exclusion of "local pathologic and metabolic factors" calls for a minimal diagnostic program to come to fairly exact findings. This includes a detailed case history with standardized and evaluated questionnaires, a bladder diary, detailed clinical examination, urine analysis consisting of microscopic and microbiologic examination, uroflowmetry including measurement of residual urine, and examination of the kidneys and the upper urinary tract (determination of creatine and sonography). Minimally invasive tests to improve validity regarding obstruction and detrusor overactivity are being developed. These tests are intended to make an invasive pressure-flow study unnecessary. However, using the above-described minimal diagnostic program, one has to take into account that patients suffering from complaints without underlying idiopathic detrusor overactivity and with urgency/urge incontinence due to bladder outlet obstruction are referred for primary therapy with anticholinergic/antispastic drugs. In cases of neurologic signs, pathologic urinary findings, reduced urinary flow rate with residual urine, and problems of the upper urinary tract, further diagnostic studies are necessary. In any case, such patients need not undergo primary therapy on the basis of a clinical diagnosis. An ex iuvantibus therapy with anticholinergic drugs--even if limited to 3 months--is not acceptable if the diagnostic minimal program is not used.

At postoperative day 10 of a percutaneous nephrolitholapaxy for a large stone in the right renal pelvis of a 78-year-old female patient, persistent gross hematuria, requiring blood transfusions, occurred. Selective renovasography showed a pseudoaneurysm of the branch of a segmental artery close to the lower renal calices. Subsequent selective placement of two "steel-coils" in the feeding artery through a coaxial catheter system resulted in complete and stable occlusion without loss of renal parenchyma. Thereafter, bleeding immediately stopped and the patient suffered no further complications. This tool of interventional radiology should be kept in mind before open surgery is considered.

Bladder cancer is a disease that occurs late in life (> 50% of the patients in Germany are 70 years or older). The general condition of the patients is frequently reduced, aggressive therapy of advanced tumours stages is therefore often contra-indicated. In this situation, palliative treatment is of extraordinary importance. Strangely enough, controlled prospective trials are lacking. They are, however, necessary in order to establish, or improve, standards of palliative treatment. Several smaller studies proved the potential of bladder irrigation and the embolisation of A. iliaca to stop bleeding from the tumourous bladder. If the tumour causes urinary retention, a permanent ureteral stent may in certain cases help to guarantee adequate flow. The assessment of palliative radiotherapy is not possible due to small numbers of (and highly selected) patients. It may have a potential in cases of hematuria, pain, and incontinence. New anti-tumour agents (e.g. Gemcitabine) may turn out to be a tolerable and effective palliative.

Hemorrhagic cystitis is a well known toxic and often life-threatening complication from high-dose chemotherapy with cyclophosphamide. The incidence is particularly high after allogeneic bone marrow transplantation. The morphologic bladder wall changes are associated with gross hematuria, clot formation in the bladder and problems to control the bleeding in up to 70% without preventive measures. Prevention is routinely done and can reduce but not obviate the incidence of hemorrhagic cystitis. Treatment is initiated by forced diuresis and continuous bladder irrigation. When necessary endoscopic cauterisation of bleeding mucosal areas is combined with the instillation of hemostyptic agents. Embolisation of the pelvic vessels or open surgery to control the bleeding is indicated in selected cases in a life-threatening situation.

Hematuria is an important symptom to be taken seriously and to be investigated quickly and thoroughly. One can distinguish between gross and microscopic hematuria as well as between initial, total and terminal hematuria. The most common cause of hematuria is bladder infection. However, because of the grave consequences bladder cancer has to be excluded. Family doctors have many tools to investigate the urine, i.e. urinary sticks, microscopic urine analysis, urine culture as well as sonography of the urinary bladder. If suspicion of bladder cancer arises further investigations by an urologist using cystoscopy, intravenous or retrograde pyelogram and sonography must be considered. Treatment of bladder cancer consists in transurethral resection of the tumor, local or systemic chemotherapy or radical cystectomy.

Hematuria is a common clinical problem. It may arise from benign diseases posing minimal risk to the patient to potentially life-threatening conditions. Due to its many causes, the evaluation of hematuria often requires various different diagnostic procedures. To prevent unnecessary diagnostic tests, the workup should begin with noninvasive techniques such as history, urinalysis, laboratory data and ultrasonography. This proceeding allows a simple and rapid differentiation in renal and non-renal causes of hematuria in most cases.

Purpose: We pointed out the value of catheter embolisation of kidney tumours., Methods and Patients: We treated 42 patients with kidney tumours. For peripheral embolisation we placed Histoacryl or Ethibloc into the kidney artery via a transfemoral catheter. 33 patients had haematuria. 8 patients were lost for follow up. 26 patients were treated by embolisation alone and 8 patients were treated before nephrectomy., Results: Haematuria was stopped in 98% and never reoccurred. The intraoperative blood-loss was 600 ml on average. 55% of patients treated by embolisation alone died within the first year. 51% of patients suffered from a slight postinfarction syndrome. One patient died of sepsis and one had pulmonary insufficiency due to AV shunt and pulmonary embolism., Conclusions: Peripheral embolisation of kidney tumours can be used successfully and is minimal invasive, in case of haematuria and pain. The perioperative risk is reduced due to limited blood loss.

In case I, a 31-year-old man who had undergone unusual high-performance training, painful swellings occurred in the left arm and creatine kinase activity was raised (28,644 U/l), as well as that of the transaminases. A rapid urine test for blood was positive, but the sediment was free of red blood cells. There were no other pathological findings. Fluid intake was increased to 31 daily and on the third day he was symptom-free and creatine kinase activity had fallen to 6475 U/l, reaching normal values on the 15th day. Case 2 concerned a 28-year-old woman with paranoid schizophrenia who had taken several tablets of clozapine and then remained in bed for 3 days. She complained of pain in the region of the gluteus maximus muscles, exacerbated on pressure but otherwise unremarkable. Creatine kinase was raised to 21,492 U/l, creatine to 186 mumol/l, and the transaminases were likewise increased. The urine strip-test for blood was twice positive. She was treated with frusemide (80 mg daily) and infusions of electrolyte solution (21 daily). She became pain-free on the second day and the various enzyme activities rapidly fell to normal.

Over a period of 15 years selective embolization of the renal artery was performed in 22 patients (15 men, 7 women; mean age 47.5 [5-73] years), using a percutaneously introduced coaxial technique with a 3F catheter. Tissue glue (N-butyl-2-cyanoacrylate) was employed in 18 cases, spiral wire in two, detachable balloon in three and gel-foam in one case. The bleeding had been iatrogenic in 20 cases, in one it was the result of a traffic accident, while in another the bleeding was from an angioma. The procedure was successful at the first attempt in 21 patients, permanently arresting bleeding in 18. There were three complications, transitory and not requiring treatment in two. In one patient gel-foam embolization went to a wrong site and a nephrectomy had to be performed.--This form of selective embolization is the treatment of choice in traumatic injury to a renal vessel.

Angiography was performed on 6 patients with acute haematuria following percutaneous nephrostomy and nephrolitholapaxy; in 3, vessel damage with leak of contrast into the nephrostomy canal or renal parenchyma was demonstrated and in 3 there were one or more pseudoaneurysms with or without arteriovenous fistula. All patients were successfully treated by catheter embolisation. Various catheter techniques (monaxial, coaxial) and embolic materials (Spongostan, Ivalon, coils) were used. The use of a Tracker-18 catheter with micro coils is the method of choice and permits superselective embolisation of bleeding from small peripheral branches with maximal preservation of the renal parenchyma.

A 51-year-old woman had been suffering from blood-stained purulent sinusitis and antibiotic-resistant bouts of fever for 4 months. She had microhematuria and serological evidence of inflammation (erythrocyte sedimentation rate [ESR] 92/135 mm, C-reactive protein 5.0 mg/dl). When she was admitted to hospital suspected of having postinfectious glomerulonephritis she complained of spontaneous colic-like pains in the left flank. Within one day the haemoglobin concentration fell from 10 to 6.5 g/dl. Ultrasound and computed tomography demonstrated a large space-occupying lesion around the left kidney. At operation this was found to be a rupture of the kidney with perirenal bleeding which was treated without removing the kidney. No biopsy was taken, but serological tests showed antineutrophil cytoplasmatic antibodies (cANCA), indicating Wegener's granulomatosis as the cause of the compensated renal insufficiency and spontaneous renal rupture. Under immunosuppressive treatment the inflammatory signs (ESR 18/44 mm), fever, chronic maxillary sinusitis, raised serum creatinine concentration and the ANCA titre all regressed, while proteinuria of about 4 g/24 h persisted. There was no recurrence during a follow-up period of 15 months. Serological signs of marked inflammatory activity, urinary sediments of nephritis and spontaneous retroperitoneal bleeding should suggest that, in addition to lupus erythematodes and panarteritis nodosa, Wegener's granulomatosis be included in the differential diagnosis.

Basing on the findings in patients with extensive carcinomas of the kidneys, the article reports on the various possibilities of application of occlusion spirals (Gianturco's method), of injectable occlusion materials and a combinations of both methods. In the authors' own experience, the spiral technique has mostly proved successful in achieving embolization of the arteries of the kidney 24 hours before surgery. Both the spiral technique as well as the use of injectable emblizates and a combination of both are used in the treatment of macrohaematurias in non-operable kidney tumours. The article reports on the technical conditions, indication and methodical limitations of embolization of the splenic artery, basing on three actual cases. The conditions and technique of embolization of branches of the hepatic artery are discussed by means of the findings obtained in two patients with liver metastases of an insulinoma.

An uncontrollable bleeding of the urinary bladder was successfully treated using a 4% formalin strip tamponade with vesico-ureteral reflux and supportive therapy with thrombocyte concentrates and transfusions of fresh blood. Non-toxic side-effects of oxazaphosphorin derivates and modern methods of prophylaxis using a uroprotectic are presented. Previously the use of formalin together with vesicoureteral reflux was contraindicated; in this case it was successfully applied for the first time via the suprapubic route using a strip tamponade.

We have carried out embolisation of malignant renal tumours using homogenised muscle in a number of patients. Since October 1974, this has been done 22 times; in six cases the tumour was inoperable. Pre-operative embolisation of resectable renal tumours makes the operative procedures easier and reduces operative risks in older patients. Haematuria, which can cause bladder obstruction, is considered a particular indication in the presence of an inoperable tumour. Tumour growth can be reduced or there may even be regression. There were no significant complications as a result of embolisation of renal tumours with autologous homogenised muscle.

9 patients with life-threatening renal bleeding of non-malignant origin, including trauma, AV fistulas, pseudoaneurysms and polycystic kidneys, were embolised after angiographic demonstration of the leakage. In all cases, the bleeding was stopped and in one case only nephrectomy was necessary 3 days after the initial embolisation procedure. Transcatheter renal embolisation should be performed as selectively as possible. With this technique most of the renal parenchyma can be saved. Embolisation is a safe and inexpensive procedure which also can be performed in critically ill patients.

Silicone elastomer was found to be suitable embolsing material in animal experiments and has been used in 16 patients. It produces permanent vascular occlusion, is easy to use, well tolerated and can be steam sterilised. The disadvantage of the method is the time taken to prepare it in the laboratory. Embolisation of tumours was successful in all cases; angiography nine months later showed that the vessels had remained occluded and that the tumours had ceased to grow or become smaller. The development of collateral vessels shows that this is only a palliative procedure and that surgery remains the main form of treatment. In ten of the 16 patients, the course of the disease was influenced beneficially.

The very first case of successful therapeutic embolization for hematuria from carcinoma of the prostate is presented. In a 76-year-old patient with necrotic carcinoma of the prostate, stage D transurethral operations showed no success. By selective intra-arterial embolization via the internal iliac arteries (using Gelfoam), hematuria could be stopped definitely and did not occur any more. Follow-up study showed no complications or necrosis in this procedure.

Over a period of 2 years pre-operative embolization of the renal artery was carried out according to the method of Gianturco, which offers certain advantages over other methods of embolization, in 25 patients with renal tumours. The most important aims of pre-operative embolization of the renal artery were considered to be to prevent tumour cells from being flooded out and to be able to ligate the vena renalis first. Because of the clinical reaction to be expected the embolization should be performed immediately before the operation, which still allows the aims to be achieved. In our opinion embolization cannot replace pre-operative irradiation.

The tissue adhesive butyl-2-cyanoacrylate mixed with lipiodol and tantulum powder is an excellent agent for superselective catheter embolisation of small vessels. The mixture is low viscous and can be injected through fine catheters. Occlusion is independent of blood clotting and is permanent. A coaxial catheter technique is recommended or, in cases of difficulty, a ballon catheter can be floated in. Super-selective embolisation was used in 15 patients, in seven for the kidney in eight for the pelvis. Indications were bleeding from the kidney, partial defunctioning of the kidney, tumours in single kidneys and bleeding from carcinomas in the bladder, prostate or cervix.

Inoperable bladder cancer and massive bleeding is an indication for selective bilateral transfemoral embolization of the internal iliac arteries. The method is preferred to the open ligation of these arteries. Histoacryl is the optimal material for longterm vascular embolization. In five patients with bleeding inoperable bladder cancer (stage T4N2) immediate and permanent haemostasis and a regression of pain was achieved.

Arterial catheter embolisation of the kidney is used as a form of treatment for uncontrollable haematuria due to inoperable tumours of the kidney or bladder; it can also be used as a preoperative measure for operable renal tumours in order to make surgery easier. Time-related morphological examinations are not yet available in the literature. The histological changes in the tumour-containing kidney are described in four patients at two, six, twelve and thirteen days after Histo-acryl embolisation. After embolisation there are wedge-shaped anaemic infarcts and extensive necrosis in tumour and normal kidney with leukocytic demarkation and reabsorption of cellular inflammatory material. Complete necrosis of the tumour was not found. There is therefore not complete destruction of the tumour as a result of arterial catheter embolisation, even when the veins are thrombosed by tumour.

In the treatment of massive hematuria after renal biopsy, selective percutaneous vaso-occlusion with detachable balloons is an effective alternative to urological surgery, as demonstrated in the case of a 39-year-old man. A review of the literature, which records success rate of more than 90% in nonmalignant renal hemorrhage, confirms the therapeutic value of the various parenchyma-sparing embolization techniques.

Transcatheter embolization of the kidneys and bladder is increasingly important. The main indication for embolization is persistent hematuria involving surgically nonaccessible renal and bladder cancer. Additional surgical management of the disease can be avoided. Another indication is the preoperative embbolization of the kidney which facilitates surgical procedure and possibly prevents tumor cell embolization in the venous circulation. The indication for embolization of bleeding bladder carcinoma is different and permanent arterial occlusion is only justified if other measurements fail.

Experimental results of embolization of normal organs did not clarify the value of transcatheter vessel occlusion in the treatment of renal carcinoma. In experimental embolization of chemically induced renal rat tumors the concept of capillary embolization was developed and showed excellent results even in end-stage tumors. In consequence this concept was adapted and transferred to clinical tumor embolization. Of 30 patients, that have been embolized up to now using Ethibloc in combination with 40% glucose as occlusion medium, one case is reported herein with a very favourable outcome. The female patient had intensive venous infiltration of a renal carcinoma accompanied by severe hematuria (T3NxM0V2). Because a patient that seems to be practically cured 30 months after embolization demonstrating massive tumor shrinkage to less than 10% of the original size in CT-controls the use of transcatheter vessel occlusion should again be investigated in association with surgical alternatives.

Successful treatment of hemorrhagic cystitis after systemic chemotherapy with cyclophosphamide yields up great problems up to now, because all therapeutic modalities that have been done were accompanied with severe side-effects. A 16 year old girl presented massive chemical cystitis and severe bleedings of the bladder mucosa after systemic long-term low-dose chemotherapy with cyclophosphamide. In this case bladder lesions could be cured completely by endoscopic application of fibrin adhesive through a cystoscope. Side-effects were not noted.