The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with bladder and urethral complications following radiation and chemotherapy.
Subjective measures:
(1) dysuria
(2) frequency
(3) hematuria
(4) incontinence
(5) decreased stream
Objective measures:
(1) hematuria
(2) endoscopy
(3) maximum bladder volume
(4) residual volume
Management measures:
(1) dysuria
(2) frequency
(3) hematuria and telangiectasia
(4) incontinence
(5) decreased stream
Analytic studies:
(1) cystography: Assessment of mucosal surface.
(2) volumetric analysis: Assessment of bladder capacity in milliliters.
(3) contrast radiography: Assessment of ulcers, bladder capacity and contractility.
(4) ultrasound: Assessment of wall thickness, sinus and fistula formation.
(5) electromyography: Assessment of sphincter activity using intraluminal pressure transducer, contraction pressure and volume curves.
If no toxicity is present, then the 0 points are assigned.
If a toxicity is present, then the grade indicates the number of points to assign.
|
Items |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
dysuria |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
frequency |
3-4 hour interval |
2-3 hour interval |
1-2 hour interval |
hourly |
|
hematuria |
occasional |
intermittent |
persistent with clot |
refractory |
|
incontinence |
less than weekly episodes |
less than daily episodes |
<= 2 pads or under-garments per day |
refractory |
|
decreased stream |
occasionally weak |
intermittent |
persistent but incomplete obstruction |
complete obstruction |
|
objective hematuria |
microscopic with normal hemoglobin |
intermittent macroscopic with < 10% decrease in hemoglobin |
persistent microscopic with 10-20% decrease in hemoglobin |
refractory, with > 20% decrease in hemoglobin |
|
endoscopic appearance |
patchy atrophy or telangiectasia without bleeding |
confluent atrophy or telangiectasia with gross bleeding |
ulcerations into muscle |
perforation, fistula |
|
maximum volume |
301 – 400 mL |
201 – 300 mL |
101 – 200 mL |
<= 100 mL |
|
residual volume |
25 mL |
26 – 100 mL |
> 100 mL |
NA |
|
management of dysuria |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgical intervention |
|
management of frequency |
alkalinization |
occasional anti-spasmodic |
regular narcotic |
cystectomy |
|
management of hematuria or telangiectasia |
iron therapy |
occasional transfusion or single cauterization |
frequent transfusion or coagulation |
surgical intervention |
|
management of incontinence |
occasional use of incontinence pads |
intermittent use of incontinence pads |
regular use of incontinence pad or self-catheterization |
permanent catheter |
|
management of decreased stream |
NA |
less than once a day self catheterization |
dilatation; more than once a day self catheterization |
permanent catheter; surgical intervention |
total score =
= SUM(points for all 14 items)
LENT score =
= (total score) / 14
Interpretation:
• maximum total score: 55
• minimum LENT score: 0
• maximum LENT score: 3.93
Specialty: Hematology Oncology, Nephrology
