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Hemorrhagic cystitis: a review.

C R deVries1, F S Freiha

  • 1Division of Urology, Stanford University School of Medicine, California.

The Journal of Urology
|January 1, 1990
PubMed
Summary
This summary is machine-generated.

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Acute bladder hemorrhage, often linked to chemotherapy drugs like cyclophosphamide, requires careful diagnosis. Prompt intervention, starting conservatively, is key for managing hemorrhagic cystitis in cancer patients and others.

Area of Science:

  • Urology
  • Oncology
  • Internal Medicine

Background:

  • Acute, fulminant bladder hemorrhage is frequently observed in cancer patients undergoing treatment with oxazaphosphorine alkylating agents, such as cyclophosphamide and isophosphamide.
  • This condition can also arise from radiation therapy for pelvic cancers, appearing years after treatment, or from medications like penicillins and danazol.
  • Hemorrhagic cystitis may occasionally signal underlying metabolic diseases or result from environmental toxins, drug use, or viral infections in otherwise healthy individuals.

Purpose of the Study:

  • To provide a comprehensive overview of the causes, diagnosis, prevention, and management of acute bladder hemorrhage.
  • To emphasize the differential diagnosis of hemorrhagic cystitis, excluding more common causes of hematuria.
  • To outline treatment strategies tailored to the severity of the clinical presentation.

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Main Methods:

  • Review of iatrogenic causes including chemotherapy (cyclophosphamide, isophosphamide), radiation, and medications (penicillins, danazol).
  • Consideration of non-iatrogenic causes such as metabolic diseases, environmental toxins, recreational drugs, and viruses.
  • Diagnostic approach emphasizing exclusion of common hematuria causes (infections, stones, tumors) before diagnosing hemorrhagic cystitis.

Main Results:

  • Oxazaphosphorine chemotherapy and pelvic radiation are significant causes of bladder hemorrhage, with delayed onset possible after radiation.
  • Diagnosis requires ruling out common urological pathologies; mild cases in healthy individuals warrant investigation into toxins, drugs, or viruses.
  • Prevention strategies include adequate hydration and prophylactic agents like mesna.

Conclusions:

  • Management of acute bladder hemorrhage involves a stepwise approach, starting with conservative measures and escalating as needed.
  • Early identification and management are crucial, especially in patients receiving chemotherapy or radiation.
  • Tailoring intervention to the clinical situation ensures optimal outcomes for hemorrhagic cystitis.