对一名四肢瘫痪男性患者进行预防性根治性膀胱切除术以治疗膀胱角化性鳞状化生。
Prophylactic radical cystectomy for the management of keratinizing squamous metaplasia of the bladder in a man with tetraplegia.
作者信息
Castillo Camilo M, Ha Chang Y, Gater David R, Grob Baruch M, Klausner Adam P
机构信息
Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249, USA.
出版信息
J Spinal Cord Med. 2007;30(4):389-91. doi: 10.1080/10790268.2007.11753958.
BACKGROUND/OBJECTIVE: To report a case of keratinizing squamous metaplasia of the bladder treated with radical cystectomy.
DESIGN
Case report and discussion of management options.
METHODS
Keratinizing squamous metaplasia of the bladder is a rare entity that can result from chronic irritative stimuli involving the bladder. It is considered a premalignant condition associated with invasive squamous cell carcinoma. A case report is presented describing the diagnosis and management of keratinizing squamous metaplasia of the bladder in a tetraplegic man with a chronic indwelling urinary catheter.
RESULTS
Radical cystectomy with an Indiana continent reservoir was performed after cystoscopy with biopsy confirmed keratinizing squamous metaplasia. Final pathology revealed focal erosion and diffuse keratinizing squamous metaplasia of the bladder with prostatic adenocarcinoma as an incidental finding.
CONCLUSIONS
Patients with spinal cord injury who use indwelling catheters for bladder management are at higher risk of developing keratinizing squamous metaplasia. Surveillance for early detection of this entity is recommended. Prophylactic cystectomy is sometimes warranted; however, observation and frequent cystoscopic surveillance to identify potential malignant transformation can be an alternative strategy. An interdisciplinary approach is recommended before consideration of bladder resection.
背景/目的：报告1例接受根治性膀胱切除术治疗的膀胱角质化鳞状化生病例。
设计
病例报告及治疗方案讨论。
方法
膀胱角质化鳞状化生是一种罕见疾病，可由涉及膀胱的慢性刺激引起。它被认为是一种与浸润性鳞状细胞癌相关的癌前病变。本文报告1例四肢瘫痪且长期留置导尿管男性患者膀胱角质化鳞状化生的诊断及治疗情况。
结果
膀胱镜检查及活检确诊为角质化鳞状化生后，行根治性膀胱切除术并构建印第安纳可控膀胱。最终病理结果显示膀胱局灶性糜烂及弥漫性角质化鳞状化生，偶然发现前列腺腺癌。
结论
使用留置导尿管进行膀胱管理的脊髓损伤患者发生角质化鳞状化生的风险更高。建议进行监测以早期发现该疾病。有时需要进行预防性膀胱切除术；然而，观察和频繁的膀胱镜监测以识别潜在的恶性转化可能是另一种策略。在考虑膀胱切除术前，建议采用多学科方法。
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