Mills R D, Studer U E
University Department of Urology, Addenbrooke's Hospital, Cambridge, England.
J Urol. 2000 May;163(5):1501-4. doi: 10.1016/s0022-5347(05)67651-3.
We present the long-term results of orthotopic bladder substitution in women.
We prospectively assessed 15 female patients undergoing orthotopic bladder substitution between October 1984 and April 1998. The indication for diversion was bladder carcinoma in 8 cases, gynecologic malignancy in 2 and benign disease in 5.
At a median followup of 19 months daytime and nighttime continence was 100% and 80%, respectively. All but 1 patient voided spontaneously. Two patients who were initially able to void successfully had voiding difficulties in the initial 10 months due to prominent mucosal tissue at the bladder neck. In each case this condition was successfully managed by endoscopic resection. There has been no local recurrence of bladder carcinoma.
With strict selection criteria and vigilant followup female orthotopic bladder substitution produces excellent long-term functional results comparable to those in men. However, the limits in women who require radical cystectomy for invasive bladder cancer cannot be determined from our results. Further long-term data on the local recurrence rate of invasive urothelial malignancy are needed before the true risk may be quantified accurately.
我们展示了女性原位膀胱替代术的长期结果。
我们前瞻性评估了1984年10月至1998年4月期间接受原位膀胱替代术的15例女性患者。改道的指征为膀胱癌8例、妇科恶性肿瘤2例、良性疾病5例。
中位随访19个月时，白天和夜间控尿率分别为100%和80%。除1例患者外，所有患者均能自主排尿。2例最初能成功排尿的患者在最初10个月因膀胱颈黏膜组织突出出现排尿困难。每例这种情况均通过内镜切除成功处理。膀胱癌无局部复发。
通过严格的选择标准和密切的随访，女性原位膀胱替代术可产生与男性相当的优异长期功能结果。然而，我们的结果无法确定因浸润性膀胱癌而行根治性膀胱切除术的女性患者的局限性。在准确量化真正风险之前，需要关于浸润性尿路上皮恶性肿瘤局部复发率的更多长期数据。
