Radiation and chemotherapy cystitis

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[edit] Discussion of Radiation and chemotherapy cystitis

[edit] Acute

  • In the acute phase of radiation and chemotherapy cystitis, there is a hemorrhagic cystitis secondary to denudation of the urothelium.
  • The most severe radiation injuries cause bladder necrosis, incontinence, and fistula formation.
  • At histologic analysis, there is cellular atypia, with mild to moderate nuclear pleomorphism. The epithelial proliferation may be so marked as to be confused with invasive cancer in the lamina propria.

[edit] Chronic

  • Beyond 1 year, chronic radiation effects result from an obliterative endarteritis in the lamina propria, followed by ischemic changes and interstitial fibrosis.

[edit] Imaging Findings for Radiation and chemotherapy cystitis

[edit] Acute

  • At imaging, there is an abnormal bladder wall with focal or diffuse irregular thickening, spasticity, and decreased distensibility.
  • Hypervascularity in the wall and bleeding vessels result in intraluminal clot, visible at US or CT.
  • MR imaging may show inflammation and edema as high signal intensity with T2-weighted sequences and can enable the bladder wall to be distinguished from clot.

[edit] Chronic

  • At imaging, a small fibrosed bladder with a thick wall and resultant hydronephrosis are seen.
  • Calcification is rarely seen.
  • Other evidence of previous irradiation includes fatty replacement of the pelvic musculature and widening of the presacral space
  • Fistulas may occur and pneumaturia and fecaluria are highly suggestive of a fistula.

[edit] Images

Patient #1

[edit] See Also

[edit] External Links

[edit] References for Radiation and chemotherapy cystitis