Chong Julio T, Dolat MaryEllen T, Klausner Adam P, Dragoescu Ema, Hampton Lance J
Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Can J Urol. 2014 Oct;21(5):7433-41.
Few studies have adequately addressed the indications, efficacy, and quality-of-life for cystectomy performed for non-malignant bladder conditions. Patients with debilitating non-malignant bladder conditions who have failed all previous conservative therapies may undergo various forms of cystectomy, including partial, simple or radical cystectomy. We provide a review of the current literature and recommendations for cystectomy for various non-malignant bladder conditions.
A systematic review of MEDLINE was conducted to find prospective and retrospective studies using the keywords "cystectomy", "benign", and non-malignant. Articles were reviewed and triaged, background articles were added as supplements, leaving a final review of 67 papers.
Data from the final review suggests that common benign indications for cystectomy are interstitial cystitis/painful bladder syndrome (IC/PBS), neurogenic bladder, hemorrhagic/radiation cystitis, infectious diseases of the bladder and miscellaneous conditions of the bladder such as endometriosis and total refractory incontinence. The most common perioperative complications include urinary tract and wound infections. Efficacy of cystectomy in patients with IC/PBS is greater than 80%, while efficacy in patients with neurogenic bladder is greater than 90%. Finally, improved urinary quality-of-life has been demonstrated in patients with neurogenic bladder post-cystectomy.
Cystectomy for non-malignant conditions can be considered for patients who have failed previous conservative therapy. The limited data in existence suggests fertility can be adequately preserved after cystectomy in younger males. The data regarding the forms of urinary diversion suggests no significant advantage between any of the major forms of urinary diversion. Finally, while newer pharmacologics and technological advances are widely used in the treatment of various benign urological conditions, their role in preventing or treating refractory benign bladder conditions have not been fully characterized.
很少有研究充分探讨因非恶性膀胱疾病而进行膀胱切除术的适应症、疗效及生活质量。患有严重非恶性膀胱疾病且先前所有保守治疗均无效的患者可能会接受各种形式的膀胱切除术，包括部分膀胱切除术、单纯膀胱切除术或根治性膀胱切除术。我们对当前文献进行综述，并针对各种非恶性膀胱疾病的膀胱切除术提出建议。
对MEDLINE进行系统综述，以查找使用关键词“膀胱切除术”“良性”和“非恶性”的前瞻性和回顾性研究。对文章进行评审和分类，添加背景文章作为补充，最终审查了67篇论文。
最终审查的数据表明，膀胱切除术常见的良性适应症包括间质性膀胱炎/疼痛性膀胱综合征（IC/PBS）、神经源性膀胱、出血性/放射性膀胱炎、膀胱感染性疾病以及膀胱的其他病症，如子宫内膜异位症和完全性难治性尿失禁。最常见的围手术期并发症包括尿路感染和伤口感染。膀胱切除术对IC/PBS患者的疗效大于80%，对神经源性膀胱患者的疗效大于90%。最后，已证明神经源性膀胱患者在膀胱切除术后尿生活质量得到改善。
对于先前保守治疗失败的患者，可以考虑进行非恶性疾病的膀胱切除术。现有有限数据表明，年轻男性在膀胱切除术后生育能力可得到充分保留。关于尿流改道形式的数据表明，任何主要尿流改道形式之间均无显著优势。最后，虽然新型药物和技术进步广泛用于治疗各种良性泌尿系统疾病，但其在预防或治疗难治性良性膀胱疾病中的作用尚未完全明确。
