Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms consistent with radiation cystitis following pelvic radiotherapy. Chief complaints include frequency, urgency, dysuria, and suprapubic discomfort. Presence of hematuria (microscopic or gross) noted. Assessment of symptom severity, impact on quality of life, and duration since completion of radiation therapy.
Clinical Examination Findings
Physical examination reveals suprapubic tenderness on deep palpation. Genitourinary exam: assessment for urethral meatal stenosis or radiation-induced skin changes in the perineal area. Digital Rectal Exam (DRE) to evaluate prostate/rectal status post-radiation. Urinalysis: presence of hematuria, pyuria, or sterile culture.
Treatment Protocol
Management plan includes: 1. Hydration therapy. 2. Antispasmodics (e.g., oxybutynin) for bladder spasms. 3. Pentosan polysulfate sodium or intravesical instillations (e.g., alum, silver nitrate, or hyaluronic acid) for refractory cases. 4. Hyperbaric oxygen therapy (HBOT) if indicated for severe hemorrhagic cystitis. 5. Surgical intervention (fulguration or cystectomy) reserved for severe, intractable cases.