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Fisteln des Urogenitaltraktes nach Strahlentherapie

Fistulas of the urogenital tract after radiotherapy

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Zusammenfassung

Hintergrund

Ein wesentlicher Bestandteil onkologischer Behandlungen besteht in einer breiten Anwendung der Strahlentherapie. Mehr als zwei Drittel der Tumorpatienten werden im Verlauf ihrer Erkrankung einer Strahlentherapie zugeführt. Neben vielfältigen potentiellen Nebenwirkungen der Strahlentherapie stellt die Ausbildung radiogener Fisteln im Urogenitaltrakt eine besondere und z. T. schwerwiegende Komplikation dar. Radiogene Fisteln können häufig neben dem Genitaltrakt der Frau den gesamten Harntrakt betreffen.

Therapie

Die potentielle Vielfalt radiogener Fisteln im Urogenitaltrakt erfordert eine an die Situation angepasste Therapie. Diese richtet sich nach dem Ausmaß und der Lokalisation der Fistel unter Berücksichtigung der Grunderkrankung. Da nach erfolgter Strahlentherapie mit erheblich kompromittierten Gewebeverhältnissen hinsichtlich der nutritiven Versorgung zu rechnen ist, sind z. T. komplexe rekonstruktive Techniken zur Wiederherstellung des Harntraktes erforderlich.

Schlussfolgerung

Radiogene Fisteln des Urogenitaltraktes stellen hinsichtlich einer effektiven Therapie eine besondere Herausforderung dar. Der Erfolg der Therapie radiogener Fisteln ist unmittelbar an die Schaffung lokal verbesserter nutritiver Gewebeverhältnisse geknüpft.

Abstract

Background

Radiotherapy plays a substantial role in the treatment of malignancies. More than 2/3 of all oncologic patients undergo radiotherapy during their specific treatment. Besides manifold side effects of radiotherapy, radiogenic fistulas of the urogenital tract are a potential severe complication. These fistulas might affect the female genital tract and the urinary tract.

Therapy

Potential manifold variety of radiogenic urogenital fistulas requires a specific therapy. Radiation tissue damage includes severely disturbed local blood supply. Consequently, in some cases extremely complex reconstructive techniques are necessary to restore the functionality of the urinary tract.

Conclusion

The treatment of radiogenic urogenital fistulas is challenging. A successful therapy can only be achieved by local improvement of the blood supply in the damaged area.

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Correspondence to Dr. A. Kocot.

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A. Kocot und H. Riedmiller geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kocot, A., Riedmiller, H. Fisteln des Urogenitaltraktes nach Strahlentherapie. Urologe 56, 329–335 (2017). https://doi.org/10.1007/s00120-017-0320-9

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Schlüsselwörter

  • Fistel, radiogene
  • Fistel, vesikovaginale
  • Fistel, rektourethrale
  • Strahlenschäden
  • Malignom

Keywords

  • Fistula, radiogenic
  • Fistula, vesico-vaginal
  • Fistula, recto-urethral
  • Radiation injuries
  • Malignom