膀胱前列腺切除术后尿道复发：对尿流改道及监测的意义

Urethral recurrence after cystoprostatectomy: implications for urinary diversion and monitoring.

作者信息

Nieder Alan M, Sved Paul D, Gomez Pablo, Kim Sandy S, Manoharan Murugesan, Soloway Mark S

机构信息

Department of Urology, University of Miami School of Medicine, Miami, Florida 33101, USA.

出版信息

Urology. 2004 Nov;64(5):950-4. doi: 10.1016/j.urology.2004.06.012.

DOI:10.1016/j.urology.2004.06.012

PMID:15533484

Abstract

OBJECTIVES

To review our cystoprostatectomy (CP) database to determine the urethral recurrence rate. Urethral recurrence after CP has been reported to occur in up to 10% of patients. Recent data have suggested a much lower incidence. This has important implications when considering the type of urinary diversion and postoperative monitoring.

METHODS

We retrospectively analyzed our single-surgeon, consecutive CP series and determined the urethral recurrence rate and prognostic factors for recurrence. Urethrectomy was performed at CP if the prostatic apical margin was positive for carcinoma. All patients were followed up quarterly for 2 years and then semiannually. Urethral wash cytology was obtained if the patient had an ileal conduit. Cytology and cystoscopy were performed if they had an orthotopic neobladder.

RESULTS

A total of 226 men had undergone radical CP. The mean age for all patients was 69 years. Eight (3.5%) had undergone urethrectomy at CP. The mean follow-up was 42 months for the remaining 218 patients, of whom 108 had an orthotopic neobladder and 110 had supravesical diversion. Of the 218 patients, 8 (3.7%) developed urethral recurrence, 7 (6.4%) in the 110 who had undergone supravesical diversion and 1 in the 108 (0.9%) who had an orthotopic neobladder. Seven patients underwent urethrectomy for the recurrence and had no evidence of disease at last follow-up. One patient died of metastatic transitional cell carcinoma at 61 months.

CONCLUSIONS

In our series, the risk of urethral recurrence after radical CP was low. The risk was substantially lower for patients who had an orthotopic neobladder. Our results show that urethrectomy at CP is rarely necessary because the proximal urethral margin is usually free of cancer. An orthotopic neobladder can therefore be safely considered in most patients. Delayed urethrectomy can be safely performed in those few patients with isolated urethral recurrence without compromising their survival.

摘要

目的

回顾我们的膀胱前列腺切除术（CP）数据库，以确定尿道复发率。据报道，CP术后尿道复发率高达10%的患者。最近的数据表明发病率要低得多。这在考虑尿流改道类型和术后监测时具有重要意义。

方法

我们回顾性分析了我们单手术医生的连续CP系列病例，确定了尿道复发率和复发的预后因素。如果前列腺尖部切缘癌呈阳性，则在CP手术时进行尿道切除术。所有患者随访2年，每季度一次，之后每半年一次。如果患者有回肠膀胱术，则进行尿道冲洗细胞学检查。如果他们有原位新膀胱，则进行细胞学检查和膀胱镜检查。

结果

共有226名男性接受了根治性CP手术。所有患者的平均年龄为69岁。8例（3.5%）在CP手术时接受了尿道切除术。其余218例患者的平均随访时间为42个月，其中108例有原位新膀胱，110例有膀胱上分流术。在这218例患者中，8例（3.7%）发生尿道复发，110例接受膀胱上分流术的患者中有7例（6.4%）复发，108例有原位新膀胱的患者中有1例（0.9%）复发。7例患者因复发接受了尿道切除术，最后一次随访时无疾病证据。1例患者在61个月时死于转移性移行细胞癌。