Huguet J
Servicio de Urología, Hospital Clínic, Barcelona, España.
Actas Urol Esp. 2012 Jan;36(1):42-7. doi: 10.1016/j.acuro.2011.06.009. Epub 2011 Aug 6.
From 4%-6% of males subjected to radical cystectomy due to urothelial carcinoma will have urethral recurrence (UR) during the follow-up.
To analyze the diagnosis, treatment and course of the patients with UR following a cystectomy.
Analysis of original articles and reviews related with the diagnosis, treatment and course of patients subjected to radical cystectomy and who develop UR. The articles were obtained from a search in PubMed.
Most of the UR appear during the first 3 years of the cystectomy. Approximately 50% of the URs of contemporary series were diagnosed through urethral cytology, the patient being asymptomatic. The urethrectomy is the treatment of choice in patients with UR and cutaneous diversion. In patients with orthotopic bladder replacement (OBR): 1) the treatment of the intraurethral BCG can be useful in patients with carcinoma in situ (CIS), 2) papillary type conservative treatment in UR has contradictory results, 3) when the uretrectomy is necessary, the ileal duct or conversion of the OBR in a continent urinary derivation can be used.
Urethral cytology is a test having high sensitivity and can contribute to the diagnosis of UR in the earliest stages. In patients with OBR, the diagnosis of a UR is a therapeutic challenge. The bladder tumor, urethral recurrence and presence of an upper urinary tract tumor in 25% of the cases may be a cause of death in these patients.
因尿路上皮癌接受根治性膀胱切除术的男性患者中，4% - 6%在随访期间会出现尿道复发（UR）。
分析膀胱切除术后尿道复发患者的诊断、治疗及病程。
分析与根治性膀胱切除术后出现尿道复发患者的诊断、治疗及病程相关的原始文章和综述。文章通过在PubMed上检索获得。
大多数尿道复发发生在膀胱切除术后的前3年。当代系列中约50%的尿道复发是通过尿道细胞学检查诊断出来的，此时患者无症状。尿道切除术是尿道复发且行皮肤造口术患者的首选治疗方法。对于原位膀胱替代（OBR）患者：1）膀胱内卡介苗治疗对原位癌（CIS）患者可能有用；2）乳头状型尿道复发的保守治疗结果存在矛盾；3）当需要进行尿道切除时，可采用回肠导管或将OBR转换为可控性尿流改道。
尿道细胞学检查是一种敏感性较高的检查方法，有助于早期诊断尿道复发。对于原位膀胱替代患者，尿道复发的诊断是一个治疗挑战。膀胱肿瘤、尿道复发以及25%的病例中存在上尿路肿瘤可能是这些患者死亡的原因。
