Yang Won Jae, Cho Kang Su, Rha Koon Ho, Lee Hye Young, Chung Byung Ha, Hong Sung Joon, Yang Seung Choul, Choi Young Deuk
Department of Urology, Inje University College of Medicine, Seoul, Korea.
Urology. 2006 Aug;68(2):324-7. doi: 10.1016/j.urology.2006.02.015.
To evaluate the functional and morphologic changes of the upper urinary tract after radical cystectomy and ileal conduit urinary diversion for bladder cancer.
Radical cystectomy and ileal conduit urinary diversion were performed in a total of 249 patients with bladder cancer at our hospital from 1980 to 1999. Of the 249 patients, 67 were excluded because of the presence of preoperative lesions in the upper urinary tract or elevated serum creatinine (greater than 1.4 mg/dL). Of the remaining 182 patients, 82 were also excluded because of incomplete follow-up or death less than 5 years after surgery.
Of the 249 patients, a total of 100 (40.2%) who had no preoperative lesions in upper urinary tract and normal renal function and survived 5 years or longer were included in this analysis. The median follow-up period was 91 months (range 60 to 193). The serum creatinine was greater than the normal range in 10 patients (10.0%), and radiologic changes in the upper urinary tract were observed in 14 patients (14.0%). They had diabetes mellitus nephropathy (4.0%) or specific comorbidities that could contribute to the deterioration of the upper urinary tract, such as ureteroileal anastomotic stricture (4.0%), chronic pyelonephritis (4.0%), urinary stones (1.0%), and upper urinary tract tumor (1.0%).
The results of our study have shown that the functional and morphologic changes in the upper urinary tract after radical cystectomy and ileal conduit urinary diversion occur in patients with specific comorbidities that could contribute to those changes. Different from previous reports, none of the upper urinary tract changes developed without an obvious cause.
评估膀胱癌根治性膀胱切除及回肠代膀胱术对上尿路的功能和形态学改变。
1980年至1999年，我院共对249例膀胱癌患者行根治性膀胱切除及回肠代膀胱术。249例患者中，67例因术前存在上尿路病变或血清肌酐升高（大于1.4mg/dL）被排除。其余182例患者中，82例因随访不完整或术后存活不足5年也被排除。
249例患者中，共有100例（40.2%）术前上尿路无病变、肾功能正常且存活5年或更长时间纳入本分析。中位随访期为91个月（范围60至193个月）。10例患者（10.0%）血清肌酐高于正常范围，14例患者（14.0%）观察到上尿路影像学改变。他们患有糖尿病肾病（4.0%）或可能导致上尿路恶化的特定合并症，如输尿管回肠吻合口狭窄（4.0%）、慢性肾盂肾炎（4.0%）、尿路结石（1.0%）和上尿路肿瘤（1.0%）。
我们的研究结果表明，根治性膀胱切除及回肠代膀胱术后上尿路的功能和形态学改变发生在有特定合并症且可能导致这些改变的患者中。与以往报道不同，上尿路改变均有明显病因。
