Editing Openai/696a86ed-b29c-800b-9b01-dda9d1d4ddf0 (section)

==== Other therapies he should be asking about (often more available than PuraStat) ====

Think of this like stopping a leak: you start with the least invasive “plumbing fixes,” and if the wall is actively flooding, you escalate quickly.

===== 1) Hyperbaric Oxygen Therapy (HBOT) =====

For radiation cystitis, HBOT is one of the most evidence-supported non-surgical options and can be done outpatient once he’s stable (no uncontrolled bleeding/clot retention). It’s commonly used in the U.S. through hospital hyperbaric/wound centers. amj.amegroups.org<ref>{{cite web|title=amj.amegroups.org|url=https://amj.amegroups.org/article/view/6232/html|publisher=amj.amegroups.org|access-date=2026-01-17}}</ref>
Key ask: “Can we start HBOT early for severe radiation cystitis, and where’s the closest hospital-based hyperbaric program?”

===== 2) Endoscopic management =====

If there are focal bleeding areas, urologists often attempt cystoscopy with clot evacuation and then cautery/fulguration or laser techniques (depends on what they see).

===== 3) Intravesical (bladder-instilled) agents =====

Common escalation options include:
* Alum irrigation (can be very effective but needs monitoring, especially kidney function)
* Aminocaproic acid (Amicar)
* Formalin (effective but higher risk; usually a later-line “big gun”) These show up repeatedly in stepwise approaches for hemorrhagic cystitis. canjurol.com<ref>{{cite web|title=canjurol.com|url=https://canjurol.com/html/free-articles/2022/29-05//Cdn_JU29-I5_06_FREE_DrDamicoS.pdf|publisher=canjurol.com|date=2022-29-05|access-date=2026-01-17}}</ref>

===== 4) Systemic antifibrinolytics (selected cases) =====

Some centers use tranexamic acid (TXA) or similar approaches in carefully selected patients (balancing clot risk vs bleeding control). amj.amegroups.org<ref>{{cite web|title=amj.amegroups.org|url=https://amj.amegroups.org/article/view/6232/html|publisher=amj.amegroups.org|access-date=2026-01-17}}</ref>

===== 5) Interventional radiology =====

If bleeding is life-altering/refractory, arterial embolization can be considered at centers with experienced IR teams. canjurol.com<ref>{{cite web|title=canjurol.com|url=https://canjurol.com/html/free-articles/2022/29-05//Cdn_JU29-I5_06_FREE_DrDamicoS.pdf|publisher=canjurol.com|date=2022-29-05|access-date=2026-01-17}}</ref>

===== 6) Last-resort options =====

In extreme, unmanageable cases: diversion/cystectomy is on the table, but that’s “end of the road” territory and exactly why getting to a major center matters. canjurol.com<ref>{{cite web|title=canjurol.com|url=https://canjurol.com/html/free-articles/2022/29-05//Cdn_JU29-I5_06_FREE_DrDamicoS.pdf|publisher=canjurol.com|date=2022-29-05|access-date=2026-01-17}}</ref>