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Therapie von Strahlenspätschäden am Harntrakt

Treatment of long-term radiation injuries in the urinary tract

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Zusammenfassung

Hintergrund

Die Strahlentherapie hat einen wesentlichen Stellenwert in der Behandlung von Malignomen. Die Nebenwirkungen und Langzeitfolgen einer Radiatio sind vielfältig und hängen von der Einzel- und Gesamtdosis, dem Zeitintervall zwischen zwei Bestrahlungen, der Größe des bestrahlten Gewebeareals sowie der Strahlensensibilität des einzelnen Gewebes ab. Die urologischen Komplikationen nach Strahlentherapie beinhalten neben entzündlichen Veränderungen der Blase (hämorrhagische Strahlenzystitis), Fibrosen mit konsekutiver radiogener Schrumpfblase, Stenosen der Harnleiter sowie die Ausbildung einer sekundären retroperitonealer Fibrose. Zudem kann es durch Nekrosenbildung zur rektourethralen, ureterovaginalen oder vesikovaginalen Fisteln bis hin zur Kloakenbildung kommen.

Therapie

Die Hauptproblematik nach Radiatio stellt die Mikroangiopathie im bestrahlten Gebiet dar. Die Therapie von Strahlenschäden im Urogenitaltrakt richtet sich nach dem Ausmaß und der Lokalisation des Strahlenschadens. In besonders schwerwiegenden Fällen sind hochkomplexe rekonstruktive Techniken zur Wiederherstellung der Funktionalität des Harntraktes und Erhalt der Nierenfunktion erforderlich.

Schlussfolgerung

Strahlenschäden können lange Zeit asymptomatisch bleiben, so dass eine engmaschige urologische Nachsorge unabdingbar ist. Die korrekte Auswahl von Darmsegmenten zur operativen Behebung von Strahlenschäden im Urogenitaltrakt ist von entscheidender Bedeutung.

Abstract

Background

Radiotherapy plays a substantial role in the treatment of malignancies. The side effects and long-term sequelae of radiotherapy are manifold and depend on the single doses and the total dosage, the time interval between two doses, the size of the irradiated tissue area and the radiation sensitivity of individual tissues. The urological complications following radiotherapy include inflammatory alterations of the bladder (radiation-induced hemorrhagic cystitis), fibrosis with subsequent radiogenic shrunken bladder, stenosis of the ureter and formation of secondary retroperitoneal fibrosis. In addition, the formation of necrosis can result in rectourethral, uterovaginal and vesicovaginal fistulas up to formation of a cloaca.

Therapy

The main problem following radiotherapy is microangiopathy in the irradiated area. The therapy of radiation injuries in the urogenital tract depends on the extent and localization of the radiation damage. In particularly severe cases extremely complex reconstructive techniques are necessary for restoration of functionality of the urinary tract and preservation of renal function.

Conclusion

Radiation injuries can remain asymptomatic for a long time so that a closely controlled urological surveillance is indispensable. The correct selection of the intestinal segments for surgical removal of radiation injuries in the urogenital tract is of pivotal importance.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Kocot u. H. Riedmiller geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Urologie und Kinderurologie, Julius Maximilians Universität Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland

    A. Kocot & H. Riedmiller

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  1. A. Kocot
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  2. H. Riedmiller
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Correspondence to A. Kocot.

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Kocot, A., Riedmiller, H. Therapie von Strahlenspätschäden am Harntrakt. Urologe 54, 1765–1771 (2015). https://doi.org/10.1007/s00120-015-4011-0

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