180 Unconjugated oestrogen for treatment of haematuria in advanced bladder cancer, post radiotherapy; a case report
Year: 2025
Type: conference-paper
Study design: Case Report
Abstract: Introduction Refractory haematuria can be a challenging symptom to treat in advanced bladder cancer which has progressed through conventional lines of treatment. Conjugated oestrogen has previously been used in treating refractory haematuria1–4, a recent report described two cases where unconjugated oestrogen had been successfully used5, we present a further case here. Case Presentation An 84-yr-old man was referred to the specialist palliative care team with a 10-month history of grade 3 invasive urothelial transitional cell carcinoma with retroperitoneal and peri-cardial lymphadenopathy. He was treated with TURBT, mini-TURP and 6 cycles of gemcitabine-cisplatin chemotherapy. Repeat imaging showed a partial response in the bladder but no change of his lymphadenopathy. He suffered from progressive grade 3 haematuria post chemotherapy, which was initially treated with bladder irrigation and palliative radiotherapy. This provided around 6–8 weeks of symptom control, but painful haematuria with 3–4 cm visible clots then recurred. He was felt to be too frail for intravesical treatments and further radiotherapy was not felt to be indicated. A trial of oral estrodiol 2mg tds was used, within 3 weeks the patient reported the clots shrinking in size and then stopping entirely. He had 8 weeks of stable symptoms without pain or passage of clots, he then had a further episode of visible haematuria, without clots. He had been globally deteriorating over this time, he died 5 days after the recurrence of haematuria. Conclusion The possibility of an oral treatment or even transdermal option is a useful adjunct in this clinical scenario, particularly in patients who may struggle with repeated hospital trips for intravesical treatments, radiotherapy or three-way catheters. Unconjugated oestrogen holds the benefit of lower rates of venous thromboembolism than conjugated oestrogen in the general population6, though the effect in the cancer population is not known. References Ordemann R, Naumann R, Geissler G, et al. Encouraging results in the treatment of haemorrrhagic cystitis with estrogen – report of 10 cases and review of the literature. Bone Marrow Transplant 2000;25:981–985. Liu YK, Harty JI, Steinbock GS, et al. Treatment of radiation or cyclophosphamide induced hemorrhagic cystitis using conjugated estrogen. J Urol 1990;144(1):41–43. Rodriguez Luna JM, Teruel JL, Vallejo JL, et al. Control of massive hematuria in idiopathic haemorrhagic cystitis after administration of conjugated oestrogen. J Urol 1992;148:1524–1525. Miller J, Burdfield GD, Moretti KL. Oral conjugated estrogen therapy for treatment of hemorrhagic cystitis. J Urol 1994;151:1348–1350. Gardner J, Husbands E. Medical management of refractory haematuria in palliative patients. Journal of Pain and Symptom Management 2024. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QReseach and CPRD databases. BMJ 2019;364:k4810.
Source: Poster presentations
Authors: Rory Kennedy, Emma Husbands
Institution: Gloucestershire Hospitals NHS Foundation Trust
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4408550494