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A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
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Hemorrhagic radiation cystitis.

William M Mendenhall1, Randal H Henderson, Joseph A Costa

  • 1*Department of Radiation, University of Florida Proton Therapy Institute †Division of Urology, College of Medicine, University of Florida, Jacksonville, FL.

American Journal of Clinical Oncology
|December 11, 2013
PubMed
Summary
This summary is machine-generated.

Managing persistent hemorrhagic radiation cystitis involves a stepwise approach. Conservative treatments are preferred initially, with more aggressive options reserved for refractory cases to minimize complications.

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Area of Science:

  • Urology
  • Radiation Oncology
  • Medical Therapeutics

Background:

  • Persistent hemorrhagic radiation cystitis is a challenging complication following pelvic radiotherapy.
  • Current management strategies lack a universally defined optimal approach.

Purpose of the Study:

  • To outline a structured management strategy for persistent hemorrhagic radiation cystitis.
  • To review available therapeutic options and their indications.

Main Methods:

  • Review of existing literature on hemorrhagic radiation cystitis management.
  • Categorization of treatments into conservative and aggressive measures.
  • Emphasis on a stepwise therapeutic escalation protocol.

Main Results:

  • A range of treatments exist, including oral agents (sodium pentosan polysulfate), intravenous drugs (WF10), topical agents (formalin), hyperbaric oxygen, and endoscopic procedures (electrical cautery, argon plasma coagulation, laser coagulation).
  • Conservative management is generally recommended first.
  • Aggressive interventions are reserved for cases unresponsive to conservative measures.

Conclusions:

  • A conservative, stepwise approach is recommended for managing hemorrhagic radiation cystitis.
  • Intervention should be judicious, starting with the least invasive options.
  • Bladder biopsies should be avoided unless malignancy is suspected due to complication risks.