Hamid Rizwan, Greenwell Tamsin J, Nethercliffe Janine M, Freeman Alexander, Venn Suzie N, Woodhouse Christopher R J
Institute of Urology and University College London Hospital, London, UK.
BJU Int. 2009 Aug;104(3):392-5. doi: 10.1111/j.1464-410X.2009.08401.x. Epub 2009 Feb 23.
To evaluate screening cystoscopy as the long-term follow up in patients with an enterocystoplasty for > or =10 years.
We performed a prospective analysis of 92 consecutive patients who attended our endoscopy suite for regular check cystoscopy as per standard follow-up. This is performed for all patients with cystoplasty performed at our institute after 10 years. The data were recorded on patient demographics, original diagnosis and type of cystoplasty. In all, 53 of these patients consented to undergo bladder biopsies at the same time.
The median (range) follow-up was 15 (10-33) years. No cancer was identified with either surveillance cystoscopy or on routine biopsies. Chronic inflammation was identified in 25 biopsies (27%). Villous atrophy was present in 12 (55%) ileal patch and three (12.5%) colonic patch biopsies. During this study, the first and only case of malignancy in a cystoplasty at our institution was diagnosed in a symptomatic patient. She had intermittent haematuria and recurrent urinary tract infections (UTIs). She previously had a normal surveillance cystoscopy.
We feel that it is not necessary to perform yearly check cystoscopies in patients with augmented bladders at least in the first 15 years, as cancer has not yet been detected with surveillance cystoscopy in this patient group. However, if the patient develops haematuria or other worrisome symptoms including suprapubic pain and recurrent unexplained UTIs a full evaluation, including cystoscopy and computerized tomography should be undertaken.
评估膀胱镜检查作为肠膀胱扩大术患者≥10年的长期随访方法。
我们对92例连续患者进行了前瞻性分析，这些患者按照标准随访流程到我们的内镜检查室进行定期膀胱镜检查。这是对我院所有接受膀胱扩大术10年后的患者进行的检查。记录患者的人口统计学数据、初始诊断和膀胱扩大术的类型。其中53例患者同时同意进行膀胱活检。
中位（范围）随访时间为15（10 - 33）年。监测膀胱镜检查或常规活检均未发现癌症。25例活检（27%）发现慢性炎症。12例（55%）回肠补片和3例（12.5%）结肠补片活检出现绒毛萎缩。在本研究期间，我院首例也是唯一一例膀胱扩大术患者发生恶性肿瘤，该患者有症状。她有间歇性血尿和复发性尿路感染（UTI）。她之前的监测膀胱镜检查结果正常。
我们认为，至少在最初15年，对于膀胱扩大术患者没有必要每年进行膀胱镜检查，因为在该患者群体中，监测膀胱镜检查尚未发现癌症。然而，如果患者出现血尿或其他令人担忧的症状，包括耻骨上疼痛和不明原因的复发性UTI，则应进行全面评估，包括膀胱镜检查和计算机断层扫描。
