Lebret T, Hervé J M, Barré P, Gaudez F, Lugagne P M, Barbagelatta M, Botto H
Department of Urology, Centre Médico-Chirurgical Foch, Suresnes, France.
Eur Urol. 1998;33(2):170-4. doi: 10.1159/000019550.
The management of the male urethra after cystectomy for bladder cancer continues to be a dilemma. Patients who undergo a cystectomy require either urinary diversion or bladder substitution. Therefore, the use of the urethra to ensure voiding is important. On the other hand, the probable risk of urethral carcinoma recurrence is generally estimated at approximately 10%. The aim of this study was to assess the predictive value of preoperative urethral biopsies, and of frozen sections during cystoprostatectomy, in patients with invasive bladder cancer.
From 1982 to 1986, 118 male patients underwent a cystoprostatectomy for transitional cell carcinoma of the bladder. All patients underwent endoscopic latero-montanal biopsies 2 weeks preoperatively and urethral frozen cut section during radical prostatocystectomy.
Carcinoma was observed in 12 patients on both examinations. All patients underwent en bloc urethrectomy during cystectomy. In the remaining 106 patients, the frozen cut margin was negative (including 9 with positive latero-montanal biopsies), and these patients had the urethra preserved. After a 10-year minimum follow-up, no recurrence was observed in these patients with negative frozen cut-section. No significant risk factors for urethral recurrence were found. Latero-montanal biopsies did not reveal a positive specificity, and this procedure was later abandoned in our institution (in 1986).
The urethral frozen section was the only guideline used for simultaneously performing the urethrectomy. All male patients with negative frozen cut sections should be considered candidates for bladder substitution. A prophylactic urethrectomy is only indicated in patients with carcinoma (minimum carcinoma in situ) in the frozen urethral margin section during cystectomy.
膀胱癌膀胱切除术后男性尿道的处理仍是一个难题。接受膀胱切除术的患者需要进行尿流改道或膀胱替代。因此，利用尿道确保排尿很重要。另一方面，尿道癌复发的可能风险一般估计约为10%。本研究的目的是评估术前尿道活检以及膀胱前列腺切除术中冰冻切片对浸润性膀胱癌患者的预测价值。
1982年至1986年，118例男性患者因膀胱移行细胞癌接受了膀胱前列腺切除术。所有患者在术前2周接受内镜下侧位活检，并在根治性前列腺膀胱切除术中进行尿道冰冻切片检查。
两次检查均在12例患者中发现癌。所有患者在膀胱切除术中均接受了整块尿道切除术。其余106例患者的冰冻切缘为阴性（包括9例侧位活检阳性者），这些患者保留了尿道。经过至少10年的随访，这些冰冻切缘阴性的患者未观察到复发。未发现尿道复发的显著危险因素。侧位活检未显示出阳性特异性，该操作后来在我们机构（1986年）被放弃。
尿道冰冻切片是同时进行尿道切除术的唯一指导。所有冰冻切缘阴性的男性患者都应被视为膀胱替代的候选者。预防性尿道切除术仅适用于膀胱切除术中冰冻尿道切缘切片有癌（至少原位癌）的患者。
