Mayo Clinic, Rochester, Minnesota 55906, USA.
J Urol. 2011 Nov;186(5):1791-5. doi: 10.1016/j.juro.2011.07.028. Epub 2011 Sep 25.
It is currently recommended that patients with congenital bladder anomalies managed by enterocystoplasty undergo annual surveillance with urine cytology and endoscopy. We reviewed our experience with this protocol and suggest modifications based on this experience.
A total of 65 patients 10 years or more after enterocystoplasty were placed on an annual surveillance protocol consisting of interval medical history, renal-bladder ultrasound, serum B12, electrolytes, creatinine, urinalysis, urine cytology and endoscopy.
Of the 65 patients 50 (77%) with enterocystoplasty (ileal in 40 and colonic in 10) remain on the protocol. Median age at the initiation of surveillance was 28 years (range 24 to 40) with a median time from augmentation of 15 years (range 12 to 29). During the first 5 years of surveillance 26 of 250 cytology results (10.5%) were suspicious for cancer. Further evaluation revealed no evidence of malignancy. Specificity for cytology was 90% with unknown sensitivity. Of 250 surveillance endoscopic evaluations 4 lesions (1.6%) were identified and biopsied/removed. Pathological evaluation revealed 1 adenomatous polyp, 1 squamous metaplasia and 2 nephrogenic adenomas. Due to the low event rate and high cost routine cytology and endoscopy were discontinued after each patient completed 5 years of followup and annual evaluations were maintained. No tumors developed during the median surveillance interval of 15 years (range 12 to 20). Currently median patient age is 42 years (range 36 to 59) and median time since augmentation is 27 years (range 23 to 40).
Due to the low incidence of malignancy, lack of proven benefit and enhanced cost containment we recommend that annual surveillance endoscopy and cytology be discontinued.
目前建议接受肠膀胱扩大术治疗的先天性膀胱异常患者每年进行尿液细胞学和内窥镜检查进行监测。我们回顾了该方案的经验，并根据该经验提出了修改建议。
共有 65 例肠膀胱扩大术后 10 年以上的患者接受了年度监测方案，该方案包括间隔病史、肾脏-膀胱超声、血清 B12、电解质、肌酐、尿液分析、尿液细胞学和内窥镜检查。
65 例患者中有 50 例（77%）继续接受肠膀胱扩大术方案（40 例为回肠，10 例为结肠）。监测开始时的中位年龄为 28 岁（范围为 24 至 40 岁），从扩大术开始的中位时间为 15 年（范围为 12 至 29 年）。在监测的前 5 年中，250 例细胞学检查结果中有 26 例（10.5%）疑似癌症。进一步评估显示无恶性肿瘤证据。细胞学的特异性为 90%，未知敏感性。在 250 次监测内窥镜评估中，发现了 4 处病变（1.6%）并进行了活检/切除。病理评估显示 1 例腺瘤性息肉、1 例鳞状化生和 2 例肾源性腺瘤。由于事件发生率低且成本高，在每位患者完成 5 年随访后，常规细胞学和内窥镜检查被停止，并且每年进行评估。在中位数为 15 年（范围 12 至 20 年）的监测间隔期间，没有肿瘤发生。目前患者的中位年龄为 42 岁（范围为 36 至 59 岁），扩大术的中位时间为 27 年（范围为 23 至 40 年）。
由于恶性肿瘤发病率低，缺乏明确的获益证据，以及成本控制增强，我们建议停止每年的监测内窥镜检查和细胞学检查。
