Stöckle M, Gökcebay E, Riedmiller H, Hohenfellner R
Department of Urology, Johannes Gutenberg University Mainz Medical School, Federal Republic of Germany.
J Urol. 1990 Jan;143(1):41-2; discussion 43. doi: 10.1016/s0022-5347(17)39858-0.
Of 273 male patients who underwent radical cystoprostatectomy between 1967 and 1987, 22 were regarded as at risk for urethral recurrence. These patients underwent simultaneous primary urethrectomy or urethrectomy shortly after cystectomy because of the histology of the cystectomy specimen. Of the remaining 251 patients a urethral recurrence was observed in 23 (9.2%). A patient with a urethral recurrence originally had undergone an operation at another hospital. The first urethral tumor recurrence was observed in 1977 but between October 1987 and May 1988, 7 patients were treated for an initial or secondary urethral recurrence. This finding suggests that the rate of urethral recurrence increases with improved survival rates after cystoprostatectomy and longer followup of these patients. Of the 24 patients who had urethral recurrence 21 showed multifocal tumor growth in the primary cystectomy specimen and 2 had unifocal tumors. The original histological status in the patient treated elsewhere is not known. The data suggest that primary simultaneous urethrectomy should be performed in all patients undergoing cystoprostatectomy for multifocal bladder tumors. Patients who retain the urethra require regular and life-long washout cytology studies of the urethra for early diagnosis of recurrent urethral tumor.
在1967年至1987年间接受根治性膀胱前列腺切除术的273例男性患者中，22例被认为有尿道复发风险。由于膀胱切除术标本的组织学情况，这些患者在膀胱切除术后同时接受了一期尿道切除术或不久后接受了尿道切除术。在其余251例患者中，有23例（9.2%）出现了尿道复发。一名尿道复发患者最初在另一家医院接受了手术。首次尿道肿瘤复发于1977年被发现，但在1987年10月至1988年5月期间，有7例患者因初次或二次尿道复发接受了治疗。这一发现表明，膀胱前列腺切除术后生存率的提高以及对这些患者更长时间的随访会使尿道复发率增加。在发生尿道复发的24例患者中，21例在初次膀胱切除标本中显示多灶性肿瘤生长，2例为单灶性肿瘤。在其他地方接受治疗的患者的原始组织学状况未知。数据表明，对于所有因多灶性膀胱肿瘤接受膀胱前列腺切除术的患者都应进行一期同步尿道切除术。保留尿道的患者需要定期进行终身尿道冲洗细胞学检查，以便早期诊断复发性尿道肿瘤。
