Abbas F, Biyabani S R, Talati J
Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
Tech Urol. 2001 Mar;7(1):20-6.
Salvage cystoprostatectomy has evolved as a safe and potentially curative treatment option for patients with radiation recurrent bladder cancer. Although orthotopic bladder replacement remains the preferred form of urinary diversion, there is minimal information about its role in salvage cystectomy series. We describe our limited experience in this regard.
We evaluated the operative characteristics and outcome of two patients with muscle invasive transitional cell carcinoma (TCC) of the urinary bladder after failed high-dose radiation therapy (mean 6,490 cGy). Both patients underwent salvage cystoprostatectomy with Studer-type ileal neobladder reconstruction. Existing literature on the topic is reviewed.
Final histopathology showed pT3 N0 M0 TCC urinary bladder with no recent evidence of tumor recurrence. There was no mortality or major perioperative complication. Mean surgery time was 590 minutes, and mean blood loss was 1,600 mL, with 3.5 U of packed cell transfusion per patient. Mean length of stay was 15 days. Postoperative complications included urinary tract infection in both cases. Prolonged urinary leakage, metabolic derangements, and loose stools were seen in one case. At a mean follow-up of 17 months, both patients have well-preserved upper tracts, normal renal function, good capacity neobladders, and satisfactory postvoid emptying. Both patients are fully continent.
Salvage cystoprostatectomy with orthotopic bladder replacement is a safe and effective management option in a select group of radiation recurrent bladder cancer patients.
挽救性膀胱前列腺切除术已发展成为放射性复发性膀胱癌患者一种安全且可能治愈的治疗选择。尽管原位膀胱替代仍然是尿流改道的首选形式，但关于其在挽救性膀胱切除术系列中的作用的信息却很少。我们描述了我们在这方面的有限经验。
我们评估了两名高剂量放疗失败后（平均6490 cGy）的膀胱肌层浸润性移行细胞癌（TCC）患者的手术特征和结果。两名患者均接受了保留前列腺的膀胱切除术及Studer式回肠新膀胱重建术。并对该主题的现有文献进行了综述。
最终组织病理学显示为pT3 N0 M0膀胱移行细胞癌，近期无肿瘤复发证据。无死亡或重大围手术期并发症。平均手术时间为590分钟，平均失血量为1600 mL，每位患者输注3.5单位浓缩红细胞。平均住院时间为15天。术后并发症包括两例均出现尿路感染。一例出现持续性尿漏、代谢紊乱和腹泻。平均随访17个月时，两名患者上尿路均保存良好，肾功能正常，新膀胱容量良好，排尿后排空满意。两名患者均完全控尿。
对于部分放射性复发性膀胱癌患者，保留前列腺的膀胱切除术及原位膀胱替代是一种安全有效的治疗选择。
