Lebret Thierry
Service d'urologie, hôpital Foch, 92150 Suresnes.
Rev Prat. 2007 Mar 31;57(6):630-40.
Invasive bladder tumours are defined as carcinomas infiltrating the muscular fibbers of the bladder wall. The assessment of tumour extension includes a clinical examination and an abdominopelvic computed tomography. The gold standard therapy is cystectomy in women and radical cystoprostatectomy in men. In patients with in situ bladder cancers, this treatment results in a five-year specific survival of 90 percent. Adjuvant chemotherapy may be considered in patients with extravesical lesions or lymphatic extension. After bladder resection, several types of urinary diversion may be considered. Ileal neobladder reconstruction, when possible, should be preferred. Patients must be monitored twice a year during the first 3 years, then once a year, to screen for a possible local or remote recurrence. The efficiency of the neobladder should be monitored regularly to ensure a satisfactory urinary voiding as well as continence acquisition, which can be achieved through auto-rehabilitation. In case of recurrence, therapeutic options should be debated in multidisciplinary team meetings; chemotherapy with cisplatin or/and gemcitabine remains the main therapeutic weapon.
浸润性膀胱肿瘤被定义为浸润膀胱壁肌纤维的癌。肿瘤扩展的评估包括临床检查和腹部盆腔计算机断层扫描。金标准治疗方法是女性行膀胱切除术，男性行根治性膀胱前列腺切除术。对于原位膀胱癌患者，这种治疗方法的五年特异性生存率为90%。对于有膀胱外病变或淋巴转移的患者，可考虑辅助化疗。膀胱切除术后，可考虑几种类型的尿流改道。如有可能，应首选回肠新膀胱重建术。在最初3年内，患者必须每年接受两次监测，之后每年监测一次，以筛查可能的局部或远处复发。应定期监测新膀胱的功能，以确保排尿满意以及获得控尿能力，这可通过自我康复实现。如果复发，应在多学科团队会议上讨论治疗方案；顺铂或/和吉西他滨化疗仍然是主要的治疗手段。
