Treatment of long-term radiation injuries in the urinary tract

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. 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. 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.