GBZ 109-2002 Diagnostic criteria for radiation-induced bladder disease
Some standard content:
ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ109-2002
Diagnostic criteria for radiation bladder disease2002-04-08 Issued
Ministry of Health of the People's Republic of China
Implementation on 2002-06-01
Chapters 4 and 5 of this standard are mandatory, and the rest are recommended. This standard is specially formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". GBZ109-2002
Radiation bladder disease is one of the most common complications of radiation injury during pelvic radiotherapy. It may occur when the lower abdomen is exposed to a large dose in radiation accidents with uneven whole-body irradiation, and it may also occur when the local dose is large in radiation accidents with local irradiation of the lower abdomen. In order to correctly diagnose and treat the disease, this standard is proposed. This standard can be used in conjunction with GBZ106-2002 "Diagnostic Criteria for Radiation Skin Diseases". This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by: Institute of Radiation Medicine, Bethune Medical University, Second Clinical College, Bethune Medical University, Third Clinical College.
The main drafters of this standard are: Jin Yuke, Wu Zhenfeng, Lu Xuejun, Liu Libo, Chen Dawei. The Ministry of Health of the People's Republic of China is responsible for the interpretation of this standard. 1 Scope
Diagnostic criteria for radiation bladder diseases
GBZ109-2002
This standard specifies the diagnostic criteria and treatment principles for acute radiation cystitis, chronic radiation cystitis and radiation bladder fistula. This standard applies to people with bladder injuries caused by medical or accidental radiation. 2 Normative references
The clauses in the following documents become clauses of this standard through reference in this standard. For all dated referenced documents, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, parties to an agreement based on this standard are encouraged to study whether to use the latest versions of these documents. For all undated referenced documents, the latest versions are applicable to this standard. GBZ106 Diagnostic Criteria for Radiation Skin Diseases 3 Terms and Definitions
The following terms and definitions apply to this standard. 3.1 Radiation Bladder Disease is caused by ionizing radiation, such as congestion, edema, ulceration and bleeding, skin cell atrophy and other damage to the bladder mucosa and its main complications. 3.2 Hematuria Normal human urine contains no red blood cells or occasionally individual red blood cells. If there are more than 2 red blood cells per high-power field of view after centrifugation or if the urine sediment cell count is collected for 3 hours, and the number of red blood cells discharged per hour is greater than 30,000 for men and greater than 40,000 for women, it is considered hematuria. In mild cases, the urine color is normal and can only be confirmed by microscopic examination, which is called microscopic hematuria. In severe cases, the urine color is bloody, which is called macroscopic hematuria. 3.3 Fecaluria: Intestinal contents entering the bladder are called fecal urine. 3.4 Pneumaturia Intestinal odor entering the urine may also be caused by infection with gas-producing bacteria in the bladder. 4 Diagnostic principles
Radiation bladder disease must be comprehensively analyzed based on the radiation history, radiation dose (with personal dose records), clinical manifestations and cystoscopic examination, and the diagnosis can only be made after excluding diseases caused by other factors. 5 Acute Radiation Cystitis 5.1 Diagnostic criteria
5.1.1 Dose threshold: cumulative dose of bladder irradiation by fractions > 30Gy; single irradiation and equivalent single irradiation bladder dose > 12Gy. Clinical manifestations: Bleeding during or 4 to 6 weeks after irradiation, clinical manifestations similar to those of infectious cystitis, such as frequent urination, urgency, urinary pain, and sometimes hematuria. Urinalysis shows an increase in the number of red blood cells, and may also increase the number of white blood cells, protein (ten), and no exfoliated cancer cells. Symptoms gradually disappear after a few days to weeks: When the radiation dose is large, it may gradually turn into chronic radiation cystitis. 5.1.3
Cystoscopy: mucosal congestion, edema and capillary dilation. The lesion is mainly located near the triangular area of the posterior wall of the bladder. Treatment principles: Stay away from radiation, strengthen nutrition, fasting foods that irritate the bladder, and drink plenty of water. Symptomatic treatment: Oral administration of Miuriling and Niantongning. Prevent urinary tract infection and treat with antibiotics when necessary. GBZ109-2002
5.2.4 Iron supplementation and hemostatic treatment.
Chronic radiation cystitis (Chronic radiation cystitis) 6
6.1 Diagnostic criteria
6.1.1 Dose threshold: cumulative dose of fractionated bladder irradiation>50Gy; single irradiation or equivalent single irradiation bladder dose>16Gy. 6.1.2 More than 6 months after irradiation, it gradually develops into chronic radiation cystitis in an average of 2 to 3 years, and the graded diagnosis is made according to the following table. Table 1 Diagnostic criteria for the classification of chronic radiation cystitis Classification Clinical manifestations Cystoscopy Frequent urination, urgency, urinary pain, mucosal congestion, edema, pain, microscopic hematuria or occasional small amount of macroscopic hematuria Focal atrophy, capillary dilatation Mucosal congestion and edema, frequent urination, urgency, urinary pain, intermittent or persistent dysuria and macroscopic hematuria, anemia 6.2 Management principles Focal atrophy, capillary dilatation, bleeding, ulcers 6.2.1 Mild chronic radiation cystitis Same as 5.2.1 to 5.2 .4 Treatment. Ultrasound examination
No obvious changes
Thickening of bladder wall,
6.2.2 In addition to the above treatments, the following treatments should be selected for severe chronic radiation cystitis. Cystography
No obvious changes
Bladder shrinkage, cavity shrinkage,
ulcer formation, may be combined with
ureteral stenosis, obstruction, renal
hydropsy of men
Urodynamic examination
Decreased urine flow rate,
reduced bladder capacity
6.2.2.1 Bladder instillation: 1:5000 azathioprine, thrombin: prednisone, gentamicin, benzocaine, belladonna with: Chinese medicine: or 3% to 5% formaldehyde, etc. Bladder instillation. bzxz.net
6.2.2.2 Systemic Supportive therapy: fluid replacement, blood transfusion. Use treatment measures that promote wound healing. 6.2.2.3 Severe bleeding should be stopped by electrocautery and laser stimulation under cystoscopy, bilateral internal iliac artery embolization or ligation, and hyperbaric oxygen therapy. 6.2.2.4 Surgical treatment when necessary.
7 Radiation vesical fistula 7.1 Diagnostic criteria
7.1.1 Dose reading: Same as 6.1.1.
7.1.2 Clinical manifestations: Vesical fistula gradually forms in the late stage after irradiation (more than 2 years), and can be divided into vesicovaginal fistula, vesicocervical fistula, and vesicoenteric fistula according to the location of the bladder fistula. Dripping urine, feces, urine, and pneumaturia occur at the perforation site. 7.1.3 Physical examination of pelvic organs, such as lower abdominal tenderness etc. 7.1.4 Methylene blue test: This is a method to check for bladder fistula. Insert a catheter from the urethra and pour 2 ml of diluted methylene blue into the bladder. If the stool is blue, it means that there is a bladder-intestinal fistula. If it flows out from the vagina, it is a vesico-vaginal fistula or a vesico-cervical fistula. If there is no fluid flowing out of the vagina, 100-200 ml of normal saline can be injected into the bladder, the catheter can be removed, and the patient can be asked to cough. If blue fluid overflows from the urethral opening, it is urinary incontinence. 7.1.5 Imaging examination: In addition to ultrasound examination, cystography or intravenous pyelography can be performed to further observe bladder wall ulcers and fistula formation, hydronephrosis, ureteral obstruction, etc. 7.1.6 Cystoscopy: Understand the congestion and edema of the mucosa around the fistula, whether the surface is smooth, the location and size of the fistula, and if the fistula is small, it will be concave. The catheter can be inserted into the vagina, cervix and vagina. When water is injected from the bladder, it will flow out from the vagina and intestines, and pay attention to observe whether there are stones. 7.1.7 Perform a colonoscopy, fiber colonoscopy, or gynecological examination when necessary. 7.2 Treatment principles: surgical repair. If there are stones and the inflammation of the bladder mucosa is not obvious, the stones can be removed and repaired at the same time; if there are stones and the inflammation of the bladder mucosa is obvious, the stones should be removed first, and the fistula should be repaired after the inflammation subsides; if there are no stones but only inflammation, anti-inflammatory drugs can be given, and the repair surgery can be performed after the urine routine is normal.
Appendix A
(Normative Appendix)
Diagnostic Standard Reference Indicators and Differential Diagnosis
And Instructions for the Correct Use of This Standard
A1The chromosome aberration rate of peripheral blood lymphocytes is significantly increasedA2The skin in the irradiated area may be accompanied by radiation skin damage, which should be treated according to GBZ106GBZ109-2002
A3Radiation cystitis should be differentiated from infectious cystitis, cystitis caused by other reasons, and hematuria caused by malignant tumor metastasis. A4 Radiation-induced bladder fistula should be differentiated from bladder fistula or urinary incontinence caused by birth injury or surgical injury. A5 Severe chronic radiation cystitis may cause ureteral stenosis or occlusion several years after irradiation due to ureteral injury or bladder scarring, resulting in hydronephrosis, pyelonephritis, and uremia. This should be differentiated from hydronephrosis caused by other reasons. A6 The dose threshold is the minimum dose value of ionizing radiation for bladder damage. Due to different irradiation conditions and personal sensitivity, the dose threshold provided in this standard is a reference value for radiation-induced bladder disease.
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