Gross hematuria is not uncommon among patients with genitourinary malignancies. It can be the presenting sign of cancer involving the urinary tract or it may arise as a direct complication of cancer treatment. In most cases, the hematuria is of mild to moderate severity and resolves with conservative measures. Some cases, however, involve intractable hemorrhage that can be life-threatening without prompt and effective treatment. Intractable gross hematuria usually arises from the bladder secondary to advanced urothelial carcinoma, severe infection, chemotherapy-induced hem-orrhagic cystitis, and radiation cystitis. Not only are these disease processes the most common causes of severe bladder hemorrhage, but they are also among the most difficult to treat. The optimal management of intractable bladder hemorrhage rests upon a determination of its cause and the institution of specific treatment at that time. Commonalities do exist, however, and they form the basis for management guidelines with broad application to all patients with severe bladder hemorrhage.
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