Date:
Patient:
Reason for Visit:
Follow-up for radiation-induced hemorrhagic cystitis (RHC)
Assessment of symptoms and response to treatment
Management of complications
History:
Presenting Illness:
Date of radiation therapy completion for underlying malignancy (specify cancer type)
Onset, duration, and severity of symptoms suggestive of RHC:
Hematuria (blood in the urine) – fresh blood may be more concerning
Urinary frequency or urgency
Dysuria (pain or burning with urination)
Pelvic pain or discomfort
Increased nocturia (frequent urination at night)
Urinary habits (voiding frequency, volume)
Functional limitations due to symptoms
Past Medical History (PMH):
Underlying malignancy and treatment details (radiation dose, field)
Prior history of urinary tract infections (UTIs) or bladder conditions
Past surgeries involving the bladder or pelvis
Physical Exam:
General: Assess for signs of dehydration or anemia (possible with chronic bleeding).
Genitourinary: Look for signs of gross hematuria or flank tenderness (suggestive of kidney involvement).
Diagnostic Tests (may be ordered depending on presentation):
Urinalysis: Presence of red blood cells (RBCs), white blood cells (WBCs) can differentiate between RHC and UTI.
Urine culture: To rule out a UTI as a cause of hematuria.
Cystoscopy (may be considered in some cases): Direct visualization of the bladder lining to assess for inflammation, ulcerations, or rule out other causes of bleeding.
Assessment:
Severity of RHC: Based on symptom severity, frequency, and impact on daily life.
Grading systems like the Radiation Therapy Oncology Group (RTOG) scoring can be used.
Presence of complications: Anemia, dehydration, urinary tract infections
Plan:
Increased oral fluids: Maintain hydration to dilute urine and decrease urinary frequency.
Bladder irritation avoidance: Limit caffeine, alcohol, spicy foods, and acidic beverages that can irritate the bladder lining.
Medications:
Hemostatic agents (e.g., tranexamic acid) to promote blood clot formation and reduce bleeding (use with caution).
Urinary tract analgesics (e.g., phenazopyridine) to relieve pain or burning with urination.
Antibiotics (if a UTI is present).
Sitz baths: Warm baths can provide pain relief and promote relaxation.
Referral to a urologist: For complex cases, severe symptoms, suspected complications (bladder strictures), or persistent hematuria.
Patient education: Provide information about RHC, expected course of symptoms, dietary modifications, medication use, and signs and symptoms to watch for (worsening hematuria, fever, flank pain).
Discuss the importance of maintaining hydration and avoiding bladder irritants.
Follow-up:
Schedule for follow-up appointments based on symptom severity.
Discuss potential for improvement or long-term management strategies for chronic RHC.
Advise the patient to contact their healthcare provider if symptoms worsen or new concerning symptoms develop (increased pain, fever, chills).
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of radiation-induced hemorrhagic cystitis