Using hydrogen peroxide as a bladder irrigation solution for clot evacuation

  • Mahdi Bagheri Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • Mamak Tahmasebi Cancer Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
  • Sheyda Najafi Mail Cancer Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
  • Zahra Jahangard Rafsanjani Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
Gross hematuria, clot evacuation, hydrogen peroxide


Gross hematuria or macroscopic hematuria is a high risk urologic condition that might occur in different settings. In the case of continued gross hematuria, blood clot size may grow and lead to complete obstruction of urinary outflow. Placement of three-way catheter, continuous bladder irrigation with normal saline, and cystoscopy are conventional treatments. Here we introduce a case with urinary obstruction who did not respond to conventional therapies. A subject of Hodgkin lymphoma with urinary obstruction caused by heavy gross hematuria was presented to emergency department. Three-way catheter was inserted to facilitate urination. However, there was no urinary drainage and bladder was distended. Consequently, 100 ml solution of hydrogen peroxide 0.15% was prepared and administered into the bladder to irrigate and evacuate the clots. A single intravesical infusion of hydrogen peroxide rapidly resolved urinary obstruction and improved patient distress. After administration of hydrogen peroxide solution, blood clots and bloody urine were evacuated successfully. These findings suggest that an intravesical injection of hydrogen peroxide can induce dissolution of blood clots and may be a simple and efficient therapy for urinary obstruction due to gross hematuria.


Hicks D, & Li CY. Management of macroscopic haematuria in the emergency department. ‎Postgrad Med J 2008; 84(996):539-44.

Ghahestani SM, & Shakhssalim N. Palliative treatment of intractable hematuria in context of advanced bladder cancer: a systematic review. Urol J 2009;6(3):149-56.

Choong SK, Walkden M, Kirby R. The management of intractable haematuria. BJU Int 2000;86(9):951-9.

Evans A, Painter D, Feneley R. Blocked urinary catheters: nurses' preventive role. Nurs Times 2001;97(1):37.

Thevarajah A. Massive haematuria with clot retention: management options. Sri Lanka J Surg 2013;30(2):18-9.

Arrizabalaga M, Extramina J, Parra JL, Ramos C, Gonzalez R, Leiva O. Treatment of massive haematuria with aluminous salts. Br J Urol 1987;60(3):223-6.

Manikandan R, Kumar S, Dorairajan LN. Hemorrhagic cystitis: a challenge to the urologist. Indian J Urol 2010;26(2):159.

Godec CJ, & Gleich P. Intractable hematuria and formalin. J Urol 1983;130(4):688-91.

Spiro LH, Hecht H, Horowitz A, Orkin L. Formalin treatment for massive bladder hemorrhage: Complications. Urology 1973;2(6):669-71.

Rao MS, Singhal PC, Bapna BC, et al. Fatal complication of intravesical formalin during control of intractable hemorrhage from radiation cystitis. Urology 1978;11(6):588-90.

Neheman A, Nativ O, Moskovitz B, Melamed Y, Stein A. Hyperbaric oxygen therapy for radiation‐induced haemorrhagic cystitis. BJU Int 2005;96(1):107-9.

Kumar AP, Wrenn Jr EL, Jayalakshmamma B, Conrad L, Quinn P, Cox C. Silver nitrate irrigation to control bladder hemorrhage in children receiving cancer therapy. J Urol 1976;116(1):85-6.

Delgal A, Cercueil JP, Koutlidis N, et al. Outcome of transcatheter arterial embolization for bladder and prostate hemorrhage. J Urol 2010;183(5):1947-53.

Warlick CA, Mouli SK, Allaf ME, Wagner AA, Kavoussi LR. Bladder irrigation using hydrogen peroxide for clot evacuation. Urology 2006;68(6):1331-2.

Wu DC, Lu CY, Lu CH, et al. Endoscopic hydrogen peroxide spray may facilitate localization of the bleeding site in acute upper gastrointestinal bleeding. Endoscopy 1999;31(3), :237-41.

Kalloo AN, Canto MI, Wadwa KS, et al. Clinical usefulness of 3% hydrogen peroxide in acute upper GI bleeding: a pilot study. Gastrointest Endosc 1999;49(4):518-21.

Sridhar S, Chamberlain S, Thiruvaiyaru D, et al. Hydrogen peroxide improves the visibility of ulcer bases in acute non-variceal upper gastrointestinal bleeding: a single-center prospective study. Dig Dis Sci 2009;54(11):2427-33.

Chang HJ, Baek SH, Choi CY, et al. Hemostatic efficacy of topical application of cold hydrogen peroxide in adenoidectomy. Korean J Otorhinolaryngol-Head Neck Surg 2003;46(11):946-9.

Al-Abbasi AM, Saeed ZK. Hydrogen Peroxide 3%: Is it Beneficial in Tonsillectomy?. Sultan Qaboos Univ Med J 2008;8(2):201.

Bannister GC, Young SK, Baker AS, Mackinnon JG, Magnusson PA. Control of bleeding in cemented arthroplasty. J Bone Joint Surg Br 1990;72(3): 444-6.

Dubey PK, & Singh AK. Venous oxygen embolism due to hydrogen peroxide irrigation during posterior fossa surgery. J Neurosurg Anesthesiol 2000;2(1):54-6.

Beattie C, Harry LE, Hamilton SA, Burke D. Cardiac arrest following hydrogen peroxide irrigation of a breast wound. J Plast Reconstr Aesthet Surg 2010;63(3):e253-4.

Belisario MA, Tafuri S, Di Domenico C, et al. H2O2 activity on platelet adhesion to fibrinogen and protein tyrosine phosphorylation. Biochim Biophys Acta 2000;1495(2):183-93.

Lapierre F, Wager M, D'Houtaud S. Hemostatic Agents in Neurosurgery. INTECH Open Access Publisher 2010.

How to Cite
Bagheri M, Tahmasebi M, Najafi S, Jahangard Rafsanjani Z. Using hydrogen peroxide as a bladder irrigation solution for clot evacuation. J Pharm Care. 3(3-4):79-81.
Case Report(s)