Durch Strahlenbehandlung verursachte Spätschäden an der weiblichen Harnblase

BS>Late sequelae in the bladder are described in 22 women who had undergone x-ray or Ra therapy for uterine cancer. In most cases clinical symptoms were absent for many months after treatment, and initially arose as hematuria 9 months to 14 yr later. Incontinence and diminished urinary capacity of the bladder were frequent subsequent signs of damage. In some cases, persistent, long-standing hematuria reflected necrotic changes in the bladder, and in some patients anastomoses between bladder and rectum were formed. In these patients, extirpation of the bladder or plastic surgery was required. Histopathologic studies of these resected bladders showed fibrosis of the connective tissue of the bladder wall and thickening of the overlying epithelial tissue. Muscle cells had been destroyed and replaced by fibroblasts, among which were multinucleated giant cells with bizarre chromatin figures. Inflammatory activity was rarely found and was confined to the upper mucosal layer in ulcerated and necrotic regions. Blood vessels showed cuffing with round cells and occasional stenosis. Large doses of radiation injured the relatively radioresistant muscle tissue, whereas lower doses affected mainly epithelium oi the bladder. (H.H.D.)