Department of Urology, University of Tuebingen, Tuebingen, Germany.
Int Braz J Urol. 2010 Sep-Oct;36(5):537-47. doi: 10.1590/s1677-55382010000500003.
Analyze current knowledge and practice regarding tumor-related cystectomy with subsequent orthotopic neobladder both in male and female patients.
DESIGN, SETTING, AND PARTICIPANTS: Evaluate literature predominantly from the last decade dealing with long-term experience in large numbers of patients with an orthotopic neobladder following cystectomy. Oncological outcome specific to an orthotopic neobladder, functional aspects such as urinary continence, renal function, sexual activity and other quality of life issues are elucidated.
Local pelvic recurrences after urothelial bladder cancer occur in 7-12%. Urethral second primary tumors in male and female patients in contemporary series with bladder substitution are 4-6% and 1.4 o 4%, respectively. Upper tract recurrences vary between 2.4-17%. Complications regarding the upper urinary tract have dramatically diminished due to simplified forms of upper tract protection as well as a more refined technique of ureterointestinal anastomosis. Depending on the technique ureteroileal stenosis was lately reported to lie between 2.7 to 3.8%. Renal function remained stable in 96% after a mean follow-up of up to 5 years.
Radical cystectomy in carefully selected patients has stood the test of time by providing adequate long-term survival and low local recurrence rates. Orthotopic bladder substitution does not compromise oncological outcome, yields excellent functional results, is cost effective compared to other types of urinary diversion, may improve quality of life and should therefore be the diversion of choice both in men and women. Chronological age is generally not a contraindication for cystectomy, but for orthotopic urinary diversion, tumor extent, functional pelvic floor deficits and general life expectancy are limiting factors.
分析男性和女性患者肿瘤相关性膀胱全切术后行原位新膀胱的现有知识和实践。
设计、环境和参与者：评估主要来自过去十年的文献，涉及对大量接受膀胱全切术后行原位新膀胱患者的长期经验。阐明了与原位新膀胱相关的肿瘤学结果、尿控等功能方面、肾功能、性行为和其他生活质量问题。
尿路上皮膀胱癌患者局部盆腔复发率为 7-12%。在当代接受膀胱替代的男性和女性患者中，尿道第二原发肿瘤的发生率分别为 4-6%和 1.4-4%。上尿路复发率为 2.4-17%。由于上尿路保护的简化形式以及输尿管肠吻合术的更精细技术，上尿路并发症显著减少。根据技术不同，输尿管-回肠吻合口狭窄的发生率最近报告为 2.7-3.8%。在平均随访 5 年以上的时间里，96%的患者肾功能保持稳定。
在精心挑选的患者中，根治性膀胱切除术通过提供足够的长期生存和低局部复发率经受住了时间的考验。原位新膀胱替代术不会影响肿瘤学结果，可获得良好的功能结果，与其他类型的尿流改道相比具有成本效益，可能改善生活质量，因此应成为男性和女性患者的首选改道方式。一般来说，年龄并不是膀胱切除术的禁忌证，但对于原位尿流改道，肿瘤范围、功能盆腔缺陷和总体预期寿命是限制因素。
