Daneshmand Siamak
USC/Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, California, USA.
Curr Opin Urol. 2015 Nov;25(6):545-9. doi: 10.1097/MOU.0000000000000226.
Orthotopic urinary diversion has been performed for more than 30 years. Although it is considered to be the gold standard form of diversion in many centers of expertise, however it is uncommonly performed outside these institutions. The purpose of this article is to review the current indications and outcomes of orthotopic diversion with a focus on male patients and to explore potential barriers to wider dissemination of the technique.
Approximately 75% of patients undergoing radical cystectomy today are candidates for orthotopic diversion and in the absence of absolute contraindications, very few patients chose to undergo an ileal conduit for personal reasons. In a recent quality of life study, the orthotopic neobladder was better than ileal conduit in terms of global health status and physical functioning. In a prospective randomized trial comparing a refluxing versus nonrefluxing neobladder, there was no difference in renal function after 3 years. There is currently insufficient evidence to suggest improved perioperative outcomes with the use of minimally invasive techniques.
There are very few absolute contraindications for an orthotopic neobladder, which remains the gold standard form of diversion at many centers of expertise. Surgeon experience and thorough preoperative counseling with realistic expectations can ensure optimal outcomes and patient satisfaction.
原位尿流改道术已开展30多年。尽管在许多专业中心它被视为尿流改道的金标准术式，但在这些机构之外却很少实施。本文旨在回顾原位尿流改道术的当前适应证和治疗结果，重点关注男性患者，并探讨该技术更广泛推广的潜在障碍。
如今，约75%接受根治性膀胱切除术的患者适合进行原位尿流改道，在没有绝对禁忌证的情况下，很少有患者因个人原因选择接受回肠膀胱术。在最近一项生活质量研究中，原位新膀胱在总体健康状况和身体功能方面优于回肠膀胱。在一项比较反流性与非反流性新膀胱的前瞻性随机试验中，3年后肾功能无差异。目前尚无足够证据表明使用微创技术能改善围手术期结局。
原位新膀胱的绝对禁忌证很少，在许多专业中心它仍是尿流改道的金标准术式。外科医生的经验以及术前进行全面、让患者抱有现实期望的咨询，可确保获得最佳治疗效果及患者满意度。
