Guidelines for Complications of Cancer Treatment Vol VIII Part B

Acute symptoms usually subside several weeks followingradiation. Management of these early symptoms is directedtoward symptom relief. In cases of dysuria, phenazopyridinehydrochloride, a topical analgesic 200mg orally, thrice a dayis frequently used to relieve the symptoms. While prescribingthis drug, the patients urine will become orange/ red. Symptomsdue to modest reduction in bladder capacity, such as mildurinary frequency and urgency maybe managed withantispasmodics like, oxybutinin chloride and the newer drugtolterodine, which is better tolerated helps to relaxes thebladder smooth muscles by inhibiting the muscarinic effectsof acetylcholine. This drug is effective in relieving symptomsof frequency and urgency. The dose is 5 mg thrice a day.Majority of these acute reactions are self- limiting and it isvery difficult to analyze due to its subjective nature.Bladder storage capacity defects and outlet resistance mustbe identified. Severe decrease in the bladder capacity may betreated with bladder augmentation using a segment of intestine.Urethral strictures are successfully managed with simpleendoscopic incisions. Though, recurrent or complex stricturemay require open surgical repair. In some patients with fixedurethral strictures and adequate bladder capacity, intermittentcatheterization may suffice.Severe haemorrhage caused by radiation maybe treated withcystoscopy and selective cauterization of bleeding pointsfollowed by irrigation with various agents like normal saline,alum, silver nitrate or dilute formalin. Early institution ofhyperbaric oxygen therapy (HBOT) has also shown positiveresults in many studies. In a study by Chong et al, 60 patientsreceived an average of 33 HBOT treatments. HBOT therapywas delivered at 2.36 atmosphere absolute pressure, with 90minutes of 100% oxygen breathing per treatment. Nearly 80%had either total or partial resolution of hematuria. When treatedwithin 6 months of hematuria onset, 96% had complete or272