deVries C R, Freiha F S
Division of Urology, Stanford University School of Medicine, California.
J Urol. 1990 Jan;143(1):1-9. doi: 10.1016/s0022-5347(17)39848-8.
Acute, fulminant bladder hemorrhage usually is seen at tertiary care centers in which cancer patients are treated with oxazaphosphorine alkylating agents, particularly cyclophosphamide and isophosphamide. These agents also are used to treat benign conditions, such as lupus erythematosis and Wegener's granulomatosis. Radiation effects from treatment of prostatic or cervical carcinoma can appear for the first time as late as 15 to 20 years after initial treatment. Other iatrogenic causes of bleeding include treatment with penicillins and, rarely, danazol. Occasionally, bladder hemorrhage may be the presenting sign of metabolic disease, such as secondary amyloidosis in rheumatic arthritis. Cases of mild to moderate hemorrhagic cystitis arising in the otherwise healthy patients should lead one to pursue the possibility of environmental toxins, accidental poisoning, recreational drug use or viruses. In all cases the diagnosis should be reserved until more common causes of hematuria, such as bacterial or fungal infection, stones, cysts or tumors, have been ruled out. Prevention of chemotherapeutically induced cystitis ideally will follow careful attention to adequate hydration and the prophylactic use of antitoxins, such as mesna. Treatment, as outlined previously, consists of a series of measures beginning with the most conservative. Intervention thereby is tailored to the gravity of the clinical situation.
急性暴发性膀胱出血通常见于三级护理中心，在这些中心，癌症患者接受氮杂磷类烷化剂治疗，尤其是环磷酰胺和异环磷酰胺。这些药物也用于治疗良性疾病，如红斑狼疮和韦格纳肉芽肿。前列腺癌或宫颈癌治疗的辐射效应最早可在初次治疗后15至20年才出现。其他医源性出血原因包括青霉素治疗，以及罕见的达那唑治疗。偶尔，膀胱出血可能是代谢性疾病的表现，如风湿性关节炎中的继发性淀粉样变性。在原本健康的患者中出现的轻度至中度出血性膀胱炎病例，应促使人们考虑环境毒素、意外中毒、使用消遣性药物或病毒感染的可能性。在所有病例中，在排除血尿的更常见原因，如细菌或真菌感染、结石、囊肿或肿瘤之前，不应做出诊断。理想情况下，预防化疗引起的膀胱炎应注意充分水化，并预防性使用解毒剂，如美司钠。如前所述，治疗包括一系列从最保守的措施开始的方法。因此，干预措施应根据临床情况的严重程度进行调整。
