Varol Celi, Thalmann George N, Burkhard Fiona C, Studer Urs E
Department of Urology, University of Bern, Inselspital, CH-3010 Bern, Switzerland.
J Urol. 2004 Sep;172(3):937-42. doi: 10.1097/01.ju.0000135626.91587.c8.
With the introduction of orthotopic bladder substitution after radical cystectomy in patients with invasive bladder cancer urethral recurrences have become a therapeutic challenge.
We retrospectively evaluated our patients with urethral recurrences treated with a urethra sparing approach after orthotopic bladder substitution. Depending on the extension of recurrence and eventual concomitant metastases patients were treated with urethrectomy, no treatment, systemic chemotherapy or intraurethral bacillus Calmette-Guerin (BCG). Three times the common dose of BCG (ImmuCyst, Aventis, Paris, France or OncoTICE, Organon, West Orange, New Jersey) in 150 ml NaCl 0.9% was used for intraurethral BCG perfusion therapy according to an institutional protocol using a modified Foley catheter. This regimen was repeated weekly for 6 weeks and patients were followed prospectively.
Between 1985 and 2001, 15 of 371 patients (4%) who received an orthotopic bladder substitute had urethral recurrence. Two patients were treated with systemic chemotherapy (methotrexate, vinblastine, doxorubicin and cisplatin) alone due to metastatic disease and 10 received intraurethral BCG therapy. Five of 6 patients (83%) with carcinoma in situ remained free of recurrence following treatment with BCG, while in 4 with papillary or invasive disease treatment failed. Three patients underwent urethrectomy, including 2 following failed BCG therapy for papillary disease.
Carcinoma in situ urethral recurrence following orthotopic bladder substitution can be treated successfully with intraurethral BCG perfusion therapy in approximately 80% of patients. However, papillary and invasive transitional cell urethral recurrence should be treated with urethrectomy.
随着浸润性膀胱癌患者根治性膀胱切除术后原位膀胱替代术的引入，尿道复发已成为一个治疗挑战。
我们回顾性评估了原位膀胱替代术后采用保留尿道方法治疗尿道复发的患者。根据复发范围及最终是否合并转移，患者接受了尿道切除术、不治疗、全身化疗或尿道内卡介苗（BCG）治疗。按照机构方案，使用改良Foley导管，将三倍常规剂量的BCG（ImmuCyst，赛诺菲，巴黎，法国或OncoTICE，欧加农，西奥兰治，新泽西州）溶于150 ml 0.9%氯化钠溶液中进行尿道内BCG灌注治疗。该方案每周重复一次，共6周，并对患者进行前瞻性随访。
1985年至2001年间，371例接受原位膀胱替代术的患者中有15例（4%）发生尿道复发。2例因转移性疾病仅接受了全身化疗（甲氨蝶呤、长春碱、阿霉素和顺铂），10例接受了尿道内BCG治疗。6例原位癌患者中有5例（83%）在接受BCG治疗后无复发，而4例乳头状或浸润性疾病患者治疗失败。3例患者接受了尿道切除术，其中2例是乳头状疾病BCG治疗失败后进行的。
原位膀胱替代术后尿道原位癌复发约80%的患者可通过尿道内BCG灌注治疗成功治愈。然而，乳头状和浸润性移行细胞尿道复发应采用尿道切除术治疗。
