尿道切除和膀胱肌瓣尿道成形术在外阴癌治疗中的应用

目的：探讨尿道切除和膀胱肌瓣尿道成形术在外阴癌治疗中的应用价值。方法：从１９７０年８月至１９９８年８月手术治疗外阴癌侵犯者７０例。肿瘤侵犯尿道外口或侵犯尿道〈１．０ｃｍ行２．０ｃｍ尿道切除３１例;肿瘤侵犯尿道下１／２段行全尿道切除３９例;全尿道切除后用膀胱颈与膀胱不分离膀胱肌瓣尿道重建１４例,膀胱颈与膀胱分离尿道重建２５例。结果：手术并发症：部分尿道切除者尿失禁４例（１２．９％）,尿道残端癌复发４例（１２．９％）;全尿道切除者膀胱阴道瘘４例,４例均发生在膀胱颈与膀胱不分离尿道重建法中,占２８．６％（４／１４）。全尿道切除病例无癌复发。本组总的５年生存率为７９％。其中部分尿道切除者为７３．１％,全尿道切除者为８３．３％。结论：部分尿道切除仅适用于肿瘤侵犯尿道外口或侵犯尿道〈１．０ｃｍ者;全尿道切除适用于肿瘤侵犯尿     

女性尿道癌（附7例报告）

本文报告女性尿道癌7例,年龄在46～60岁间,病理上以鳞状上皮癌为多见(4例)。病因尚不清楚,但慢性刺激、尿道肉阜、尿道憩室、尿道狭窄与尿道癌发生有一定关系。7例中手术治疗4例,其中3例行前盆腔脏器切除,输尿管乙状结肠吻合术,2例并行淋巴结清扫术,但疗效均不满意。另1例行全尿道连同膀胱颈以及小阴唇切除后做膀胱肌瓣尿道成形术,随访2年,排尿正常。     

应用TUR术治疗膀胱癌膀胱全切术后复发性尿道癌

目的：探讨膀胱癌行膀胱全切术后尿道复发的治疗方法.方法：回顾性分析膀胱癌行膀胱全切术患者216例,其中术后复发尿道癌15例（6.9％）,复发平均时间18（3-46）个月.15例患者术后因肉眼血尿（7例）、血性分泌物（3例）及排尿不畅（5例）再次就诊.均经尿道膀胱镜检查及尿道冲洗细胞学检查确诊.尿道镜活检报告为尿道尿路上皮癌,病理分期为Ta-T1.15例均行TUR术,术后辅以羟基喜树碱灌注治疗.结果：15例患者术后平均随访36（6-52）个月.其中12例患者健在,未见肿瘤复发及转移;1例术后14个月肿瘤复发,行全尿道切除＋尿液转流术,随访至今未见肿瘤再次复发及转移;1例术后8个月肿瘤复发,行全尿道切除＋阴道前壁、侧壁、子宫及附件切除＋盆腔淋巴结清扫术,术后9个月死于肿瘤多发转移;1例死于心肌梗死.结论：膀胱癌膀胱全切术后复发尿道癌可应用TUR术治疗,临床效果良好且生活质量较高.早期诊断与治疗是保证预后的关键.     

男性膀胱移行细胞癌累及尿道的诊治

目的：探讨与膀胱癌相关的尿道癌的发病特点及诊治。方法：对471例膀胱移行细胞癌中发生的16例尿道受累的发病特点进行分析,结果文献讨论本病的 诊断及治疗方法。结果：尿道移行细胞癌发生率占同期膀胱癌患者的3.4%;16例膀胱癌累及尿道的患者皆为男性;膀胱癌多发（包括原位癌）的13例;肿瘤侵犯膀胱颈部或三角区的14例;膀胱癌病理分级Ⅱ级：7例,Ⅲ级：9例。结论：膀胱多发肿瘤、位于膀胱颈或三角区的肿瘤以及高分级肿瘤是尿道癌发生的危险因素。尿道肿瘤的诊断依靠膀胱尿道镜检查及活检、尿道冲洗液脱浇细胞学检查,膀胱切除术中标本尿道切缘 冰冻病理检查对诊断和确定治疗方案有重要意义。     

一种新的女性尿道成形术

外阴癌是女性外阴最常见的恶性肿瘤,长期以来以手术治疗为主。手术是否彻底,直接影响疗效。外阴癌常累及尿道,故手术要彻底,必须将尿道及周围的组织一并切除。为使病人正常排尿,我们设计了膀胱褶叠成形代尿道的术式。自1987年4月以来治疗9例,其中8例保留膀胱括约肌,均获成功,1例行膀胱括约肌连同部分膀胱切除,手术失败。临床资料患者年龄51岁～82岁,平均年龄64岁。菜花型、溃疡型各2例,结节型5型。尿道口癌3例,前庭部癌4例,阴道前壁和双侧大阴唇癌各1例。按FIGO分期法,Ⅲ期1例,Ⅳ期1例。主要症状是尿病、尿频、排尿困难。9例均为鳞状上皮癌。     

保留膀胱手术治疗女性晚期原发性尿道癌的探讨

女性晚期原发性尿道癌的治疗 ,通常是在全尿道切除同时 ,需行全膀胱切除 尿流改道术。但晚期未侵犯膀胱的尿道癌 ,我们主张保留膀胱。 1990年 -1997年我们收治 5例女性晚期原发性尿道癌。现总结报告如下 ,并结合文献加以讨论。1　资料与方法1.1　一般资料本组 5例 ,年龄 45岁～ 76岁 ,平均6 2 .5岁。5例患者均可触及尿道肿块 ,其收稿日期 :1999-12 -0 7作者单位 :安徽省六安市人民医院 ,安徽　六安　 2 3 70 0 5中伴尿道出血、尿频、尿急、尿痛 4例 ;排尿困难 1例。触及腹股沟淋巴结肿大 1例。IVP示双肾积水 1例。尿道造影、膀胱 CT及膀…     

女性原发性尿道癌8例报告

 本文报告女性原发性尿道癌8例,年龄在41-63岁,平均年龄(?)3岁,与文献报告的基本一致。前尿道癌7例,后尿道癌1例。腺癌5例,鳞癌2例,移行细胞癌1例。行单纯放疗3例,其中2例分别生存18、11个月,1例失访;肿瘤加部份尿道切除,术后放疗1例,现已15个月健在;全尿道切除加膀胱壁瓣尿道重建术3例,均获满意近期疗效;1例未治。笔者认为,本病以手术治疗为主,全尿道切除加膀胱壁瓣尿道重建术是目前最理想的治疗方法。     

浅表性膀胱癌二次经尿道电切的意义

目的:探讨对表浅性膀胱癌实施二次经尿道膀胱肿瘤电切术的指征和意义。方法:以确立的二次经尿道膀胱肿瘤电切术入选标准对126例表浅性膀胱癌患者实施手术,满足条件的81例患者中32例拒绝二次手术为A组,49例在术后4周行二次经尿道膀胱肿瘤电切术为B组,2组患者术后膀胱灌注相同。所有患者随访2年,比较2组间膀胱肿瘤进展率和复发率。结果:A组患者在术后2年随访中共有14例出现复发,分别为术后半年3例,1年内8例,1年至2年间6例。B组的16.3%（8/49）患者在第二次手术时发现肿瘤。2年随访期间复发8例,其中1年内3例,1年后5例,2组间在肿瘤复发上有统计学差异。结论:二次经尿道膀胱肿瘤电切术能降低非肌层浸润性膀胱癌患者的肿瘤复发;切除标本中有无肌层是明确手术切除彻底的标志。经尿道膀胱肿瘤电切术需要经验丰富的医师实施。     

女性原发性尿道癌四例报告

女性原发性尿道癌少见,发病率占女性恶性肿瘤的0.02％,我院1968年以来收治4例,现报告如下。临床及病理资料4例年龄为40岁～68岁,平均54岁,均为已婚经产农妇。病程:8个月～1年2例,3～5年2例。症状:主要为尿频、尿疼及排尿困难。其中1例发生急性尿潴留,1倒排出脓血性分泌物,术前诊断均为尿道癌,其中2例发病初期分别在外院诊断为尿道“息肉”,1例当时切除未活检,不久复发;1例未予切除,病变均继续发展至排尿困难而转入本院。治疗:均行全尿道切除。其中同时行膀胱与直肠吻合术者1例,耻骨上膀胱造瘘及腹股沟淋巴结清扫术1例。术后3例放疗,1例化疗。病理检查见肿瘤均为蕈状型,小者2×2×1cm,大者3.5 ×3×2cm,3例累及前尿道,1例累及全尿道并腹股为淋巴结转移。镜检:鳞状细胞癌2例,乳头状移行细胞癌1例,腺癌1例。术后结果:鳞癌1例生存5年2个月,1例术后2年失访,其余2例生存期均未超过1年6个月。     

经尿道切除膀胱多发肿瘤和巨大肿瘤

目的:探讨经尿道切除膀胱多发肿瘤和巨大肿瘤的治疗效果。方法:采用经尿道膀胱肿瘤切除（TUR-BT）手术治疗29例膀胱多发肿瘤和/或巨大肿瘤,术后常规膀胱灌注,5例接受系统性化疗。每3个月行膀胱镜检查,必要时再次行TUR-BT手术或全膀胱切除术。结果:术后病理结果均为膀胱癌。随访3-72月,18例存活5年以上。在所有病例中,4例术后1年内死于肿瘤转移,8例无瘤生存,17例术后1-3年复发。复发病例中14例再次或多次行TUR-BT手术,2例行全膀胱切除术,1例行单纯尿流改道手术。结论:经尿道切除膀胱多发肿瘤和巨大肿瘤可以获得较好的治疗效果,根治性TUR-BT辅以系统性化疗或许是膀胱多发肿瘤和/或巨大肿瘤而又希望保留膀胱的病人的理性选择。     

Involvement of the anterior urethra in male patients with transitional cell-carcinoma of the bladder undergoing radical cystectomy with simultaneous urethrectomy

Histological tumor extension into the prostate, urethra and ureters was examined in 52 specimens obtained by cystourethrectomy for transitional cell carcinoma of the bladder with one or more risk factors for urethral involvement. In four (21.1%) of 19 patients with diffuse carcinoma in situ in the bladder extending to the internal urethral orifice and prostatic urethra, the anterior urethra was affected by transitional cell carcinoma, including one specimen with invasion into the corpus spongiosum. However, none of 33 patients without these findings had synchronous anterior urethral transitional cell carcinoma involvement. It is recommended that patients with diffuse carcinoma in situ extending into the prostatic urethra undergo careful preoperative assessment of the anterior urethra before cystectomy. In other cases, the anterior urethra can be preserved and used for orthotopic neobladder replacement.      

经尿道膀胱黏膜与膀胱颈联合电切配合术后吡柔比星灌注治疗女性腺性膀胱炎临床研究

目的:探讨经尿道膀胱黏膜与膀胱颈联合电切配合术后吡柔比星灌注治疗女性腺性膀胱炎的临床效果。方法:选取2009年-2013年在我院接受治疗的腺性膀胱炎女性患者120例。随机分为观察组与对照组,每组60例。两组患者均给予经尿道膀胱黏膜与膀胱颈联合电切术。在次基础上,观察组给予术后吡柔比星进行治疗。观察两组治疗效果、尿动力学指标、不良反应,并随访复发结果。结果:观察组治疗显效29例,有效26例,无效5例,治疗有效率为91.67%;对照组治疗显效21例,有效25例,无效14例,治疗有效率为76.67%。观察组治疗有效率明显高于对照组（P＜0.05）。观察组最大尿流率为（24.32±6.31）ml/s,平均尿流率为（12.67±5.98）ml/s,最大尿道压为（7.21±1.72）kPa;对照组最大尿流率为（17.87±8.75）ml/s,平均尿流率为（7.99±5.43）ml/s,最大尿道压为（10.98±3.01）kPa。观察组膀胱刺激征7例,骨髓抑制0例,肾功能损害1例,皮疹1例,尿道狭窄1例,不良反应发生率为16.67%（10/60）;对照组膀胱刺激征12例,骨髓抑制3例,肾功能损害2例,皮疹3例,尿道狭窄2例,不良反应发生率为36.67%（22/60）。对两组患者随访,随访率100%。观察组随访时间为（14.34±3.43）个月,对照组随访时间为（14.04±3.41）个月,两组随访时间无显著差异（P＞0.05）。观察组复发率为15.00%,对照组复发率为31.67%。结论:经尿道膀胱黏膜与膀胱颈联合电切配合术后吡柔比星灌注治疗女性腺性膀胱炎治疗效果显著,且复发率低,临床上值得推广。     

Urethral involvement in female patients with bladder cancer. A study of 22 cystectomy specimens

The cystectomy specimens of 22 female patients with various types of bladder cancer were studied for evidence of urethral involvement. The bladder showed high-grade invasive transitional cell carcinoma in 18 patients, in 14 cases in association with flat carcinoma in situ (multifocal in 11 cases and unifocal in three). Three patients had multifocal carcinoma in situ of the bladder without evidence of invasion, and one patient had multifocal high-grade noninvasive papillary carcinoma. Urethral carcinoma in situ was observed in four of 14 patients (29%) with multifocal carcinoma in situ of the bladder, in three cases extending into the periurethral glands. This frequent concurrence of carcinoma in situ of the bladder with urethral and periurethral gland involvement, analogous to the carcinomatous involvement of the prostatic urethra and ducts in male patients, warrants caution in the intravesical therapy of female patients with superficial bladder cancer. The urethra showed invasive carcinoma in three of 18 patients (17%) with invasive bladder cancer (stromal invasion in two cases and vascular invasion in one). This finding reconfirms the use of routine urethrectomy in conjunction with cystectomy in female patients with invasive bladder cancer. An incidental finding was the presence of condylomatous changes in the urethra in five cases (23%).     

21例原发女性尿道癌临床分析

[目的]探讨原发性女性尿道癌的临床特点、治疗及预后。[方法]回顾性分析21例原发性尿道癌临床资料。[结果]原发性女性尿道癌好发于中老年,平均年龄54岁,全部病灶见于尿道口,以尿道口肿物、尿路刺激症为主要表现,病理以腺癌和鳞癌多见,放射和手术为主要治疗方式。生存时间6天-273个月,早期病例及鳞癌预后较好,晚期病例及腺癌和移行上皮癌预后较差。[结论]原发女性尿道癌的预后与分期、病理类型,治疗方法有关。     

Continence after radical prostatectomy with bladder neck preservation.

PURPOSE: Bladder neck preservation during radical prostatectomy has been advocated for improving urinary continence. We evaluate bladder neck preservation looking at continence rates, surgical cancer control and bladder neck contracture. MATERIALS AND METHODS: A total of 40 patients underwent retropubic radical prostatectomy for clinically localized carcinoma of the prostate. The prostatic urethra was dissected in continuity with the bladder away from the lumen of the prostate, which allows for a true urethra-to-urethra anastomosis. RESULTS: Continence was noted immediately in 26 patients, within 2 weeks in 9 and within 6 weeks in 3. Only 2 patients required pads 3 months postoperatively. Microscopic positive surgical margins were noted in 2 of 40 patients. In 1 patient the urethral margins were not involved with carcinoma. In the other patient the urethra was not the sole positive margin and microscopic positive margins were noted elsewhere. Early results of cancer control were good. CONCLUSIONS: Early follow-up of this technique of radical retropubic prostatectomy suggest that preservation of the continence mechanism at the level of the bladder neck and prostatic urethra results in significantly improved postoperative urinary continence without adversely affecting cancer control.     

Primary carcinoma of the female urethra: single center experience of 18 cases

BACKGROUND: Primary carcinoma of the urethra is more common in women than in men. Vague symptoms in the early stages delay the diagnosis in most patients. Surgery and radiotherapy are used as treatment modalities for these tumors, either alone or in combination. METHODS: We retrospectively analyzed the records of 18 female patients with urethral cancer presented to our institution. Secondary tumors involving the urethra from adjacent organs like bladder carcinoma and gynecological cancer were excluded. RESULTS: In our review, the overall survival was 74% at 3 years and 33% at 5 years with median overall survival of 51 months. There was a statistically better overall survival in patients with early stage tumors compared with later stage disease (P = 0.03) and patients with distally located tumors had better survival compared with proximal and whole urethral involvement. CONCLUSIONS: The prognosis is poor in advanced stages and in those with proximal or whole urethral involvement, requiring extensive surgical procedures. The aim of treatment in distal urethral carcinomas should be local excision and radiotherapy, thereby preserving the bladder.     

Carcinoma of the female urethra

From 1962 to 1980, 24 patients with primary urethral carcinoma and 1 vulval cancer involving the urethra were treated in our hospital. In this series, the mean age was 52 years. 23 lesions in the distal (anterior) urethra were all diagnosed preoperatively. Pathological classification were as follows: squamous cell carcinoma 16, adenocarcinoma 3, transitional cell carcinoma and undifferentiated carcinoma 4. The chief method of treatment were resection of the tumor and reconstruction of a new urethra, using bladder flap in two forms: abdominal urethra and reconstructed urethra in the original position. Preoperative or postoperative irradiation was given in one third of the patients. 17 patients have shown satisfactory results in the follow-up. The 7 and 10 year survival rates are 36% and 18% among 11 patients who are living and well.     

Hypospadia in females

Hypospadia is a frequent birth deformity consisting in fissure of the posterior (lower) wall of the urethra. Hypospadia is characterized by shortening of the urethra and ectopia of the external urethral opening. This deformity often occurs in women but is rarely diagnosed because physicians are not well-informed about female hypospadia. Classification of anatomic variants of female hypospadia proposed by the authors includes low vaginal ectopia of the external urethral opening; high vaginal ectopia of the external opening of the urethra; urovaginal (vesicovaginal) fusion of the neck of the urinary bladder with vagina accompanied with enuresis; urogenital sinus in females (ectopia of the external urethral opening in the urogenital sinus); any of the above variants of female hypospadia in combination with false or true hermaphroditism. All the variants of female hypospadia must be surgically corrected as transposition of the external opening of the urethra from the vagina on the perineum under the clitoris in chronic urethritis, cystitis and vulvovaginitis or as urethroplasty in enuresis. Hypospadia, urogenital sinus and hermaphroditism--three anomalies of human urogenital system--combine rather frequently.     

Urethra-sparing cystectomy and orthotopic urinary diversion in women with malignant pelvic tumors.

BACKGROUND: To the authors' knowledge, few data exist regarding the functional and oncologic outcome of pelvic tumors in women with urethra-sparing cystectomy and orthotopic urinary diversion to the urethra. PATIENTS AND METHODS: The combined data of 102 women age 28-79 (mean, 59 yrs) years who underwent a urethra-sparing cystectomy and orthotopic urinary diversion for either primary bladder cancer (96 patients), carcinoma of the uterine cervix (2 patients), carcinoma of the vagina (1 patient), primary fallopian tube carcinoma (1 patient), uterine sarcoma (1 patient), or rectal carcinoma (1 patient) were reviewed. The histology of the 96 primary bladder tumors was 81 transitional cell carcinomas (TCC), 8 adenocarcinomas, 5 squamous cell carcinomas, 1 small cell carcinoma, and 1 unclassified. Follow-up ranged from 1.5-100 months (mean, 26 mos; median, 24 mos). In all patients, the bladder neck and up to 1 cm in length of the adjacent urethra were removed with the bladder. An ileal orthotopic neobladder procedure was performed if staging biopsies of the bladder neck and intraoperative frozen section of the urethral margin revealed no tumor. RESULTS: There was no perioperative mortality, and an early and late complication rate requiring secondary intervention in 5 (5%) and 12 (12%) patients. With 88 of 102 patients alive and 83 of 102 patients disease free, a disease-specific survival of 74% and a disease-free survival of 63% was estimated at 5 years. No pelvic recurrence was seen in 81 patients with TCC. Three pelvic recurrences occurred, two tumors of the inner genitalia and one adenocarcinoma of the bladder, none of them in the area of the urethra or its supplying autonomic nerves. Daytime continence was 82%; nocturnal continence was 72%. Twelve (12%) patients were unable to empty their bladders completely and needed some form of catheterization. CONCLUSIONS: The functional and oncologic outcome of female patients with an orthotopic urinary diversion to a remnant urethra was found to be comparable to that found in large studies on males. An orthotopic neobladder proved to be an oncologically safe option for women with pelvic tumors and was found to provide quality of life when there was adherence to previously defined selection criteria.