Ham Won Sik, Kim Won Tae, Jeon Hyung Jin, Lee Dong Hoon, Choi Young Deuk
Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
J Urol. 2009 Apr;181(4):1594-9; discussion 1599. doi: 10.1016/j.juro.2008.11.099. Epub 2009 Feb 23.
We evaluated the long-term outcome of simultaneous transurethral bladder tumor and prostate resection in patients with nonmuscle invasive bladder tumor and bladder outlet obstruction.
Between April 1997 and April 2006, 213 patients with nonmuscle invasive bladder tumor who had a minimum followup of 24 months were included in the study, including group 1-107 with transurethral resection of bladder tumor only and group 2-106 with transurethral bladder tumor and prostate resection. Simultaneous transurethral bladder tumor and prostate resection was performed at surgeon discretion. The records were retrospectively analyzed for clinicopathological parameters, recurrence and progression rates, time to recurrence and postoperative uroflowmetry results in the 2 groups.
There were no significant differences in clinicopathological parameters between the 2 groups. At a mean followup of 54.3 and 50.1 months in groups 1 and 2, respectively, group 2 patients with a tumor less than 3 cm or a single tumor had a significantly lower recurrence rate than group 1 patients. None of the 31 patients with recurrence in group 2 had recurrence in the bladder neck or prostatic urethra where transurethral prostate resection had been done. There was no significant difference in the progression rate between the 2 groups. The 60-month recurrence-free probability in groups 1 and 2 was 43.4% and 52.0%, respectively. Three months after surgery the postvoid residual urine volume had significantly decreased in group 2.
Simultaneous transurethral bladder tumor and prostate resection may help decrease bladder cancer recurrence and delay time to recurrence without the risk of cancer implantation when transurethral prostate resection is done, especially in patients with a papillary, solitary-appearing bladder lesion less than 3 cm.
我们评估了非肌层浸润性膀胱肿瘤合并膀胱出口梗阻患者同期经尿道膀胱肿瘤与前列腺切除术的长期疗效。
1997年4月至2006年4月期间，纳入213例非肌层浸润性膀胱肿瘤患者，这些患者至少随访24个月，其中1组107例仅行经尿道膀胱肿瘤切除术，2组106例行经尿道膀胱肿瘤与前列腺切除术。同期经尿道膀胱肿瘤与前列腺切除术由外科医生酌情决定。对两组患者的临床病理参数、复发和进展率、复发时间及术后尿流率结果进行回顾性分析。
两组临床病理参数无显著差异。1组和2组的平均随访时间分别为54.3个月和50.1个月，2组中肿瘤小于3 cm或单发肿瘤的患者复发率显著低于1组。2组31例复发患者中，无1例在经尿道前列腺切除术部位的膀胱颈或前列腺尿道复发。两组进展率无显著差异。1组和2组60个月无复发生存概率分别为43.4%和52.0%。术后3个月，2组患者的残余尿量显著减少。
同期经尿道膀胱肿瘤与前列腺切除术可能有助于降低膀胱癌复发率并延迟复发时间，且在进行经尿道前列腺切除术时无肿瘤种植风险，尤其适用于乳头状、单发、直径小于3 cm的膀胱病变患者。
