Guidelines for Complications of Cancer Treatment Vol VIII Part B

after radiation therapy, bladder irritation varies from milddysuria with infrequent hematuria to protracted bladder spasm,continous hematuria, necrosis and may be eventual vesicovaginalor urethra-vaginal fistula. The overall rate of urinarysequelae in cancer cervix patients is frequently reported in the8-12% range, while the rate of moderate/ severe sequelae is inthe 2-6% range.While (ICRU 38) report attempts to make the reporting of thebladder dose uniform, it is clear that this technique is ladenwith uncertainties, which was confirmed in various studies.Acute symptoms include pain during micturition, increasedurinary frequency, and urgency. The reported incidence of theseacute symptoms varies widely from 23 to 80% among patientsreceiving pelvic radiation for various tumors. The symptomsare usually subjective, occasionally severe, and therefore maynot always be appreciated and reported by the patient.Diagnosis, Prevention and ManagementA careful history, physical examination, and urinalysis isusually sufficient to assess the degree of bladder dysfunction.Patients should be evaluated for the presence of obstructiveor irritative symptoms. An urge incontinence must bedistinguished from stress incontinence. A urinary tract fistulamust be ruled out in women with large volume or continuousincontinence.The suprapubic region and abdomen must be palpated to assessbladder distention and tenderness. A meticulous gynecologicalexamination must be performed to exclude the presence ofinflammatory conditions or fistula. A carefully collected, cleanurine sample should be examined for the presence of bacteriaand red and white cells. Urinary infection can greatly augmentthe effects of radiation which requires prompt attention. Urinecytology and culture sensitivity is also helpful in indicatingthe source of infection.271