Department of Urology, University Hospital of Bern, Bern, Switzerland.
J Urol. 2010 Apr;183(4):1337-41. doi: 10.1016/j.juro.2009.12.017. Epub 2010 Feb 19.
We review the functional and oncologic outcomes of seminal vesicle and prostate capsule sparing cystectomy combined with ileal orthotopic bladder substitution.
Between May 2003 to April 2009 a select group of 31 patients (median age 61 years, range 30 to 77) underwent seminal vesicle sparing cystoprostatectomy for transitional cell carcinoma of the bladder. Preoperatively all 31 patients were continent, and 23 (74%) were potent and sexually active. Of these patients 17 (55%) underwent unilateral and 14 (45%) underwent bilateral seminal vesicle sparing cystoprostatectomy. Pathological disease stage was pTa/pT1 in 15 patients (48%), pT2 in 9 (29%), pT3 in 2 (7%) and pT2-4 pN1 in 5 (16%). Urinary continence and potency outcomes were assessed with validated questionnaires. All patients were followed for local tumor recurrence and distant metastasis.
Median followup was 18 months (range 3 to 63). At 6 months 25 of the 30 evaluable patients (83%) had daytime continence and 13 of 30 (43%) had nighttime continence. At last followup (median 18 months) 27 of 29 evaluable patients (93%) had daytime continence and 19 of 29 (66%) had nighttime continence. In terms of postoperative potency 15 of 19 evaluable patients (79%) remained potent, 9 with oral medications. There was pelvic recurrence in 1 patient (3%), distant metastases developed in 4 (13%) and 1 (3%) died of metastatic transitional cell carcinoma.
Individualized seminal vesicle and nerve sparing cystoprostatectomy resulted in a high probability of preserving potency, at least with oral medication, without putting patients at undue risk.
我们回顾了保留精囊和前列腺囊的膀胱部分切除术联合回肠原位膀胱替代术的功能和肿瘤学结果。
2003 年 5 月至 2009 年 4 月，一组 31 例（中位年龄 61 岁，范围 30 至 77 岁）患者因膀胱癌接受了保留精囊的膀胱部分切除术。术前所有 31 例患者均有控尿能力，23 例（74%）有能力且有性生活。这些患者中有 17 例（55%）行单侧，14 例（45%）行双侧保留精囊的膀胱部分切除术。病理疾病分期为 pTa/pT1 期 15 例（48%），pT2 期 9 例（29%），pT3 期 2 例（7%），pT2-4 pN1 期 5 例（16%）。采用已验证的问卷评估尿控和性功能结果。所有患者均随访局部肿瘤复发和远处转移。
中位随访时间为 18 个月（范围 3 至 63 个月）。6 个月时，30 例可评估患者中有 25 例（83%）有日间控尿能力，30 例中有 13 例（43%）有夜间控尿能力。末次随访（中位时间 18 个月）时，29 例可评估患者中有 27 例（93%）有日间控尿能力，29 例中有 19 例（66%）有夜间控尿能力。就术后性功能而言，19 例可评估患者中有 15 例（79%）仍有能力，其中 9 例服用口服药物。1 例（3%）患者出现盆腔复发，4 例（13%）出现远处转移，1 例（3%）死于转移性移行细胞癌。
个体化的保留精囊和神经的膀胱部分切除术保留了性功能的高可能性，至少通过口服药物可以做到，且不会使患者承担不必要的风险。
