18.12Hemorrhagic Cystitis, Dysuria

18.12.1General

•Causes of hemorrhagic cystitis: viral infections (e.g., adenoviruses, BK virus, CMV, particularly in the immune-compromised patient), drugs (e.g., ifosfamide and cyclophosphamide)

•Early phase of cystitis: edema of mucous membranes, inflammation, ulceration. Late complications: fibrosis of bladder, vesicoureteric reflux, hydronephrosis

•Causes of dysuria: infectious diseases, disorders of spinal cord, pelvic spaceoccupying processes, drugs (opioids, phenothiazines, vinca alkaloids)

18.12.2Diagnosis

•Symptoms: dysuria, hematuria, clots in urine

•Radiology: ultrasound

•Laboratory analysis: complete blood count with differential count, hemostasis testing (prothrombin time, activated partial thromboplastin time, thrombin time) fibrinogen, D-dimers, urinalysis and culture, and/or PCR (bacteria, fungi, viruses).

•Possibly cystoscopy (ice-water irrigation, electrocoagulation)

18.12.3Treatment

•Consider urethral catheter, bladder irrigation. Hydration, if needed packed red cell and platelet transfusion, as well as support of hemostasis (fresh-frozen plasma, factor VIIa, antifibrinolysis, and pain control, i.e., morphin and spasmolytica)

18.13Acute Alteration of Consciousness

18.13.1General

•Neurological emergencies in oncology may be based on direct or indirect effects of cerebral space-occupying processes and their management. Causes of acute alteration of consciousness: intracranial hemorrhage, brain infarction, infectious diseases (encephalitis, brain abscess), metastases, leukoencephalopathy, increased intracranial pressure

18.13.2Diagnosis

•Multidisciplinary collaboration needed

•Symptoms: Time of occurrence of symptoms and their duration affect differential diagnosis: fatigue, somnolence, coma, seizures