Departamento de Urologia, Hospital do Câncer de Barretos, Barretos, SP, Brasil.
Int Braz J Urol. 2018 Sep-Oct;44(5):1036-1041. doi: 10.1590/S1677-5538.IBJU.2018.0005.
Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.
标准根治性膀胱切除术（RC）在女性中涉及到远端输尿管、膀胱、近端尿道、子宫、卵巢和相邻的阴道的切除。此外，为治疗选定的女性而保留盆腔器官的 RC 已成为一种被接受的技术，与标准 RC 相比，它可能会带来更好的术后性功能和尿控功能，避免了尿失禁、脱垂、新膀胱-阴道瘘（NVF）和性功能障碍等并发症，而不会影响肿瘤学结果。本文报告了一种不同的手术方法：一位患者在 RC 后使用先前的回肠原位新膀胱进行了皮肤连续性储尿袋和新阴道的构建。患者没有出现并发症，没有疾病复发的迹象，并且具有活跃的性生活，同时拥有一个令人满意的连续性储尿袋。该病例是首例能够同时治疗因阴道短缩和新膀胱-阴道瘘引起的性交困难的报告。总之，不保留阴道的标准根治性膀胱切除术可能会对生活质量产生负面影响。在本病例中，我们通过将先前的回肠原位新膀胱分为两部分：一个连续性储尿袋和一个新阴道，成功地治疗了新膀胱瘘和阴道短缩。然而，为了在这类患者中确立最佳的治疗方法，还需要更多的长期随访病例。
