USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA 90089, USA.
World J Urol. 2012 Dec;30(6):741-5. doi: 10.1007/s00345-012-0861-x. Epub 2012 Mar 29.
To review the perioperative and follow-up outcomes of patients undergoing radical cystectomy with orthotopic neobladder reconstruction for bladder cancer after prior radical prostatectomy (RP) for prostate cancer.
A retrospective review of more than 1,900 patients treated with radical cystectomy at USC between 1990 and 2011 was conducted. Fifty-six patients were identified who were previously treated with RP for prostate cancer. Twenty-four of these patients (43 %) underwent orthotopic neobladder reconstruction. Perioperative data and follow-up including postoperative continence were analyzed.
The median age at cystectomy for these 24 patients was 68 years (range 55-89). The types of neobladder reconstruction were Kock neobladder in 3, Sigmoid reservoir in 1, Studer neobladder in 12, and T-pouch ileal neobladder in 8 patients. There were no major intraoperative complications. Of 19 patients eligible for evaluation of post-cystectomy urinary control, 11 patients (57.9 %) with good continence (0-1 pad/day) after RP regained preoperative level of urinary control after cystectomy within 1 year. The continence rate of 13 post-RP patients with good continence was 84.6 %. Among the 4 patients who received adjuvant radiotherapy after RP, 1 regained good continence. One with poor continence after prostatectomy had an artificial urethral sphincter (AUS) placed 2 months after cystectomy, and 2 with fair and poor continence after prostatectomy had an AUS placed at the time of cystectomy.
Patients undergoing radical cystectomy after prior RP pose a challenge to urologists. Those who are continent post-RP have a fair chance of regaining good urinary control with neobladder reconstruction. Adjuvant radiotherapy for prostate cancer may have a negative impact on continence with neobladder reconstruction.
回顾在因前列腺癌接受根治性前列腺切除术（RP）后因膀胱癌而行根治性膀胱切除术和原位新膀胱重建的患者的围手术期和随访结果。
对 1990 年至 2011 年期间在南加州大学接受根治性膀胱切除术治疗的 1900 多名患者进行了回顾性分析。确定了 56 例先前因前列腺癌接受 RP 治疗的患者。其中 24 例（43%）接受了原位新膀胱重建。分析了围手术期数据和随访结果，包括术后控尿情况。
这 24 例患者的中位年龄为 68 岁（55-89 岁）。新膀胱重建的类型为 Kock 新膀胱 3 例、乙状结肠储尿囊 1 例、Studer 新膀胱 12 例、T 型 pouch 回肠新膀胱 8 例。无重大术中并发症。19 例有资格评估膀胱切除术后尿控的患者中，11 例（57.9%）在 RP 后有良好的控尿（0-1 片/天），在 1 年内恢复了术前的尿控水平。在 RP 后有良好控尿的 13 例患者中，控尿率为 84.6%。在 4 例接受 RP 后辅助放疗的患者中，1 例恢复了良好的控尿。1 例在前列腺切除术后控尿不佳的患者在膀胱切除术后 2 个月放置了人工尿道括约肌（AUS），2 例在前列腺切除术后控尿一般和不佳的患者在膀胱切除时放置了 AUS。
在接受根治性前列腺切除术（RP）后接受根治性膀胱切除术的患者对泌尿科医生来说是一个挑战。那些在 RP 后有控尿的患者有一定的机会通过新膀胱重建恢复良好的尿控。前列腺癌的辅助放疗可能对新膀胱重建后的控尿产生负面影响。
