Stein John P, Penson David F, Wu Simon D, Skinner Donald G
Department of Urology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, California 90089, USA.
J Urol. 2007 Sep;178(3 Pt 1):756-60. doi: 10.1016/j.juro.2007.05.013. Epub 2007 Jul 13.
Before the early 1990s total urethrectomy at radical cystectomy for bladder cancer in women was considered the standard of care. As our understanding of the natural history of urethral urothelial carcinoma in women has improved, neobladders have been increasingly created in carefully selected women with bladder cancer. We reviewed the literature regarding the incidence of urethral involvement, the risk factors for urethral involvement and the incidence of urethral recurrence in women undergoing orthotopic urinary diversion for bladder cancer.
A comprehensive literature review was performed regarding the natural history of urethral tumor involvement by urothelial carcinoma, risk factors and the incidence of urethral recurrence following radical cystectomy and orthotopic diversion in women with bladder cancer.
Urethral tumor involvement occurs in approximately 12% of female patients with bladder cancer undergoing radical cystectomy for high grade, invasive urothelial carcinoma. Preoperative involvement of the bladder neck or anterior vaginal wall with urothelial carcinoma is an important risk factor for urethral tumor involvement. Intraoperative frozen section analysis of the proximal urethra is an appropriate and reliable method of identifying female candidates for orthotopic diversion. The rate of secondary tumor recurrence in the retained urethra of women following radical cystectomy and orthotopic urinary diversion is low but the condition requires long-term followup.
Orthotopic urinary diversion can be performed safely in appropriately selected women with bladder cancer. Excellent oncological outcomes can be expected with a minimal risk of urethral recurrence. Preoperative bladder neck involvement is an important risk factor for urethral involvement but not an absolute contraindication to orthotopic diversion should intraoperative frozen section of the proximal urethra be without evidence of malignancy.
在20世纪90年代早期之前，女性膀胱癌根治性膀胱切除术时行全尿道切除术被视为标准治疗方法。随着我们对女性尿道尿路上皮癌自然史的认识不断提高，对于精心挑选的膀胱癌女性患者，越来越多地采用新膀胱术。我们回顾了有关女性膀胱癌患者接受原位尿流改道术时尿道受累发生率、尿道受累危险因素及尿道复发率的文献。
对女性膀胱癌患者行根治性膀胱切除术及原位尿流改道术后尿道肿瘤受累的自然史、危险因素及尿道复发率进行了全面的文献回顾。
在接受根治性膀胱切除术治疗高级别浸润性尿路上皮癌的女性膀胱癌患者中，约12%发生尿道肿瘤受累。术前膀胱颈或阴道前壁尿路上皮癌受累是尿道肿瘤受累的重要危险因素。术中对近端尿道进行冰冻切片分析是识别适合原位尿流改道女性患者的一种合适且可靠的方法。女性患者根治性膀胱切除术及原位尿流改道术后保留尿道的继发性肿瘤复发率较低，但该情况需要长期随访。
对于经过适当选择的膀胱癌女性患者，可以安全地进行原位尿流改道术。预期可获得良好的肿瘤学结局，尿道复发风险最小。术前膀胱颈受累是尿道受累的重要危险因素，但如果术中近端尿道冰冻切片未发现恶性证据，并非原位尿流改道的绝对禁忌证。
