Hematuria and Urinary Frequency After Cancer Chemotherapy

Oral administration of cancer medication can cause hematuria?

Hello Doctor, I have a friend who has been undergoing oral chemotherapy with Capecitabine for eight months due to cancer.
He developed hematuria and increased urinary frequency, prompting the doctor to immediately discontinue the medication.
Despite being prescribed bladder care and antibiotics, there has been no improvement.
Subsequent imaging studies, including a CT scan, bladder ultrasound, and urinalysis, revealed bladder wall thickening and excessive crystals, but no evidence of urinary tumors.
The doctor concluded that the crystals from the chemotherapy drug caused sterile cystitis and advised that stopping the medication and increasing fluid intake would lead to improvement.
However, it has been nearly three months since discontinuation, and the hematuria and urinary frequency have not improved.
Initially, the urine color was light pink or dark red, but recently it has turned bright red, and there have also been episodes of incontinence.
My friend needs to urinate over ten times every two hours.
The doctor has not found any other solutions.
Could the crystals truly be the cause of the hematuria? What options are available for improvement?

Oudoubao, 40~49 year old female. Ask Date: 2020/12/19

Dr. Jian Weihong reply Urology

Frequent urination and incontinence may be caused by hematuria, which could be due to cystitis induced by cyclophosphamide.
Additionally, it is important to be cautious as cyclophosphamide may also lead to bladder cancer.
It is generally recommended to undergo cystoscopy for examination and treatment; this can help stop the bleeding and remove blood clots, as well as rule out bladder cancer and assess the severity of cystitis.
Literature from abroad indicates that hyperbaric oxygen therapy has shown promising results, although there are cases where it has been ineffective.
In instances of severe hematuria lasting over 18 months, a ureterostomy may be performed, allowing urine to bypass the bladder and flow directly through the stoma.
The pressure from the bladder filling with blood may naturally stop the bleeding.
In such severe cases, encountering hemorrhagic cystitis as a serious side effect may require long-term collaboration between the patient and healthcare providers for effective management.

Reply Date: 2020/12/19

More Info

Hematuria, or blood in the urine, and urinary frequency can be distressing symptoms, particularly following chemotherapy treatment. In your friend's case, the onset of these symptoms after eight months of taking the chemotherapy drug, likely a form of chemotherapy known as "Carmustine" or "BCNU," raises several important considerations.

Firstly, the development of hematuria and urinary frequency can indeed be linked to the effects of chemotherapy. The drug in question can lead to the formation of crystals in the urine, which may irritate the bladder lining and result in a condition known as sterile cystitis. This irritation can cause symptoms such as hematuria, increased urinary frequency, and urgency. The fact that imaging studies and urine tests did not reveal any tumors is reassuring, but it does not eliminate the possibility of drug-induced bladder irritation.

The recommendation to increase fluid intake is a common strategy to help flush out the urinary system and reduce the concentration of any irritating substances, including drug crystals. However, if symptoms persist despite these measures, further evaluation is warranted. The presence of fresh blood in the urine, especially if it has changed from a lighter color to bright red, is concerning and should not be ignored. This change could indicate a more significant issue, such as ongoing irritation or even damage to the bladder lining.

In cases where conservative management does not yield improvement, a cystoscopy may be warranted. This procedure allows a urologist to directly visualize the bladder and urethra, assess for any abnormalities, and potentially perform therapeutic interventions, such as removing any blood clots or treating areas of irritation. Additionally, a biopsy may be performed if there are suspicious areas that need further evaluation.

Regarding the urinary frequency and incontinence, these symptoms can be secondary to the irritation of the bladder. The bladder may become hypersensitive due to inflammation, leading to increased urgency and frequency of urination. In some cases, medications that relax the bladder or reduce inflammation may be beneficial. Anticholinergic medications or beta-3 adrenergic agonists are often used to manage overactive bladder symptoms, but these should be prescribed and monitored by a healthcare professional.

If your friend continues to experience these symptoms, it is crucial to maintain open communication with their healthcare provider. They may need to explore additional treatment options or referrals to specialists, such as a urologist, who can provide more targeted interventions.
In summary, while the initial assessment points towards drug-induced irritation as a likely cause of hematuria and urinary frequency, the persistence and worsening of symptoms necessitate further investigation. It is essential to ensure that there are no underlying complications and to explore appropriate management strategies to improve your friend's quality of life.

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