Four cases of persistent hemorrhage occurring after megavoltage irradiation ( approximates 5000 rad) for extensive bladder neoplasm are described. The complication after megavoltage therapy is regarded as an extremely serious condition; if it is not controlled by conservative measures within 2 to 3 weeks, total cystectomy should be considered, even if cystoscopy shows that the original tumor has almost completely disappeared. Cystoscopic diathermy is not practicable, and ligation of the internal iliac arteries is not effective. The bleeding, however, can usually be controlled by transvesical diathermy excision of the bleeding area. It is suggested that the hemorrhagic lesions induced in the bladder by irradiation may follow necrotizing arteriolitis, although this was not verified by biopsy studies. (H.H.D.)
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D. P. R. Turner (1961) studied this question.