| Genitourinary Tract | ||
| Hemorrhagic Cystitis | Cells lining bladder are destroyed by chemotherapy (e.g., cyclophosphamide, ifosfamide). Side effect of radiation when located in treatment field. | Encourage increased fluid intake 24-72 hr after treatment as tolerated. Monitor manifestations such as urgency, frequency, and hematuria. Administer cytoprotectant agent (mesna [Mesnex]) and hydration. Administer supportive care agents to manage symptoms (e.g., lavoxate [Urispas]). |
| Reproductive Dysfunction | Cells of testes or ova are damaged by therapy. | Discuss possibility with patients before treatment initiation. Offer opportunity for sperm and ova banking before treatment for patients of childbearing age. |
| Nephrotoxicity | Direct renal cell damage from exposure to nephrotoxic agents (cisplatin and high-dose methotrexate). Precipitation of metabolites of cell breakdown (tumor lysis syndrome [TLS]). | Monitor BUN and serum creatinine levels. Avoid potentiating drugs. Alkalinize the urine by adding sodium bicarbonate to IV infusion and administer allopurinol (Zyloprim) or rasburicase for TLS prevention |
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