Severe chemical cystitis from the transurethral intravesical insertion of a vaginal contraceptive suppository: a report of 3 cases and proposed method of management

Abstract

We report on 3 patients who sustained severe chemical cystitis from the inadvertent insertion of a nonoxynol-9 containing vaginal contraceptive suppository into the bladder. A suggested treatment schedule is presented and the toxicity of nonoxynol-9 is discussed.

PIP: Case reports are presented on 3 patients who sustained severe chemical cystitis from the inadvertent insertion of a nonoxynol-9-containing vaginal contraceptive suppository into the bladder. A treatment schedule is suggested, and the toxicity of nonoxynol-9 is discussed. In Case 1, a 23-year-old woman had marked urinary urgency following inadvertent insertion of a vaginal contraceptive suppository into the bladder via the urethra. Emergency cystoscopy revealed severe chemical hemorrhagic cystitis with pain. The bladder was irrigated copiously with saline, and 50 cc 1% lidocaine, 100 mg hydrocortisone, and dimethyl sulfoxide were instilled intravesically. The substance in the suppository was a detergent, thus no specific treatment was performed. In case 2, a 22-year-old woman was hospitalized for severe symptoms of urgency, marked dysuria, and severe burning pain following inadvertent insertion of a vaginal suppository into the bladder. A 3-way Foley catheter was inserted, and oxybutynin and ciprofloxacin therapy was initiated. Bladder irrigations were begun with normal saline. She received 100 mg hydrocortisone intravenously every 8 hours. Cystoscopy revealed diffuse severe hemorrhagic cystitis. Retrograde cystography with the patient under anesthesia demonstrated a bladder capacity of only 300 cc. The patient had severe bladder spasms for approximately 1 month after initial insertion of the vaginal suppository. A serious fixed drug eruption developed in the right leg secondary to the nonoxynol-9. In case 3, a 26-year-old woman presented to a urology clinic 36 hours after transurethral insertion of a vaginal suppository into the bladder. Cystoscopy revealed severe hemorrhagic cystitis. The patient was treated with 1 tablet of trimethoprim-sulfamethoxazole twice a day and 5 mg oral oxybutynin every 6 hours. Significant irritation was reported using latex condoms lubricated with nonoxynol-9. The absorption of the drug via the bladder wall occurs rapidly and reaches high concentrations.