Sarosdy M F
Division of Urology, University of Texas Health Science Center, San Antonio.
Urol Clin North Am. 1992 May;19(2):391-6.
All patients with locally advanced transitional-cell carcinoma of the bladder should undergo thorough precystectomy assessment of the prostatic urothelium for evidence of malignancy. Those with carcinoma or carcinoma in situ should not be considered candidates for orthotopic continent diversion, and urethrectomy should be recommended. Regardless of risk status, all patients with a urethral remnant after cystectomy should have semiannual urethral washings performed for cytologic analysis. Any positive result should be followed by urethrectomy. By identifying and modifying the treatment plan for those patients who are clearly at increased risk of developing a urethral recurrence, it should be possible to reduce the morbidity and anxiety that urethral recurrence can entail. More importantly, the risk of noncompliance in follow-up with disastrous results is reduced, and both the patient and the physician can be assured that the best management for urothelial malignancy has been offered, not simply isolated treatment of the primary bladder carcinoma.
所有局部晚期膀胱移行细胞癌患者在膀胱切除术前均应接受对前列腺尿路上皮的全面评估，以寻找恶性肿瘤证据。患有癌或原位癌的患者不应被视为原位可控性尿流改道术的候选者，应建议行尿道切除术。无论风险状态如何，所有膀胱切除术后有尿道残余的患者均应每半年进行一次尿道冲洗以进行细胞学分析。任何阳性结果均应行尿道切除术。通过识别并修改那些明显有较高尿道复发风险患者的治疗方案，应能够降低尿道复发可能带来的发病率和焦虑。更重要的是，降低了随访中不依从导致灾难性后果的风险，并且患者和医生都可以确信已提供了对尿路上皮恶性肿瘤的最佳管理，而不仅仅是对原发性膀胱癌的孤立治疗。
