von Rundstedt F-C, Lazica D, Brandt A S, Mathers M J, Roth S
Klinik für Urologie und Kinderurologie, Helios-Klinikum, Universität Witten-Herdecke, Heusner Strasse 40, 42283, Wuppertal, Deutschland.
Urologe A. 2010 Jan;49(1):69-74. doi: 10.1007/s00120-009-2144-8.
The remaining bladder is an almost forgotten entity. We analyzed the literature and present patient data from our institution.
We studied patients at our institution who received a supravesical urinary diversion without concomitant cystectomy and reviewed the relevant literature to extract pros and cons for daily practice. This retrospective study was performed in nine patients at our institution (seven women and two men) with a median age of 40 years who underwent supravesical urinary diversion without concomitant cystectomy between 1972 and 2008 for benign conditions such as incontinence, neurogenic bladder or bilateral megaureters. The median follow-up was 10 years. Additionally we performed an extensive literature search where all such patients who underwent urinary diversion without concomitant cystectomy for benign indications were identified in different retrospective analyses by various authors.
The most common complications were pyocystis (2/9), bleeding (3/9), and pain-related symptoms (1/9). Secondary carcinoma occurred in two cases. Secondary cystectomy was performed in one patient. In one patient the creation of a vesicovaginal fistula resolved the pyocystis completely.
The indication to leave the bladder in situ requires individual considerations. Due to potential complications and the progress in surgery with regards to maintaining sexual function a cystectomy should be offered to young patients. In the aging patient however a defunctionalized bladder can be discussed. The urologist should be aware of the potential complications and perform regular follow-up.
残余膀胱几乎是一个被遗忘的实体。我们分析了文献并展示了来自我们机构的患者数据。
我们研究了在我们机构接受膀胱上尿路改道且未同时行膀胱切除术的患者，并回顾了相关文献以提取日常实践中的利弊。这项回顾性研究纳入了我们机构的9例患者（7名女性和2名男性），他们的年龄中位数为40岁，在1972年至2008年期间因诸如尿失禁、神经源性膀胱或双侧巨输尿管等良性疾病接受了膀胱上尿路改道且未同时行膀胱切除术。中位随访时间为10年。此外，我们进行了广泛的文献检索，在不同作者的各种回顾性分析中确定了所有因良性指征接受尿路改道且未同时行膀胱切除术的此类患者。
最常见的并发症是膀胱积脓（2/9）、出血（3/9）和疼痛相关症状（1/9）。2例发生了继发性癌。1例患者接受了二期膀胱切除术。1例患者因形成膀胱阴道瘘而使膀胱积脓完全消退。
保留膀胱原位的指征需要个体化考虑。由于存在潜在并发症以及在维持性功能方面手术的进展，对于年轻患者应考虑行膀胱切除术。然而，对于老年患者，可以讨论无功能膀胱的处理。泌尿外科医生应意识到潜在并发症并进行定期随访。
