A patient undergoing chemotherapy complains of painful urination and blood in the urine. What is the most likely diagnosis?

• A. Bladder cancer
• B. Haemorrhagic cystitis
• C. Urinary tract infection
• D. Kidney stones

Answer: (B)

Chemotherapy can irritate the bladder lining, especially with regimens that use cyclophosphamide or ifosfamide, because a metabolite called acrolein damages the bladder mucosa. When a patient receiving chemotherapy reports painful urination and blood in the urine, this combination is most consistent with hemorrhagic cystitis. The irritative urinary symptoms plus visible blood in the context of cytotoxic therapy point toward bladder irritation and bleeding from treatment, rather than a primary cancer presenting with painless hematuria or a urinary infection that would usually be accompanied by fever or pyuria. Kidney stones can cause hematuria but typically present with severe, colicky flank pain and different pain patterns, not just dysuria in a chemo patient. Management focuses on prevention and symptom control in high-risk regimens (hydration and mesna to neutralize acrolein), plus ruling out infection and assessing for bleeding severity.