Palliative Care Unit, Kanto Medical Center NTTEC, Tokyo, Japan.

Urologic emergencies in malignancies are difficult to treat for non-urological medical staff because of their anatomical specificity and sensational susceptibility. Urological cancer pain involves somatic and neuropathic problems. In pelvic malignancies, almost always NSAIDs, micro-2-agonisitic opioids and adjuvant analgesics are necessary for pain palliation. The inducements of hemorrhagic cystitis are radiation, chemotherapy and tumor invasion. Although there are some conservative treatments such as hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis, in emergency circumstances selective embolization of the internal iliac artery may be beneficial with fewer side effects. In uncontrollable tumor bleeding, palliative radiotherapy(maximum dose of 30-36 Gy)is effective. The most important problem in voiding disturbance is bladder outlet obstruction. Sometimes patients are treated with alfa-adrenergic blockers effectively, but eventually they may need an indwelling catheter. Obstructive nephropathy due to malignant ureteral obstruction is an ominous sign of progressive disease, especially in pelvic malignancies. The mean survival rate of 12 months was less than 30%.

Article in Japanese

Written by:
Hori N, Suzuki M.   Are you the author?

Reference:
Gan To Kagaku Ryoho. 2008 Dec;35(13):2321-5.

PubMed Abstract
PMID:19098398

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