The acute changes in the bladder during radiotherapy include inflammation and mucosal oedema. The proliferation of vascular endothelium continues several months after the treatment. Obliterative endarteritis with perivascular fibrosis result in ischemia185. Telangiectasia can be observed. Smooth muscle fibrosis, with collagen deposition, is responsible for the reduction of bladder capacity (urinary frequency, urgency)186-188. Cystitis is a syndrome characterized by irritative symptoms such frequency and dysuria; hematuria may or may not be a part of cystitis (RTOG definition)98. The SOMA/LENT score for bladder and urethral complications includes dysuria, frequency, hematuria, incontinence and decreased stream103.

Bladder complications occur later than rectal complications: around 80% of them are present within 40 months after the end of the treatment; their median time of appearance is 23-30 months96,97,99.

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