膀胱根治性切除术后继发尿道癌的临床分析

目的总结膀胱癌行根治性膀胱切除术后继发尿道癌的临床特点,以提高诊治能力。方法回顾性分析2000年至2014年98例膀胱癌行根治性膀胱切除术后继发尿道癌6例的临床资料,其中3例行可控回结肠代膀胱术,1例行原位膀胱术,2例行回肠膀胱术。发生尿道癌时间为术后5~36个月。行尿道膀胱镜检查4例位于后尿道残端,2例位于前尿道,活检证实均为尿道尿路上皮癌,1例CT发现后尿道癌浸润周围组织及盆腔和腹股沟淋巴结的转移。4例行经会阴全尿道切除术,1例行经尿道肿瘤电切术,6例均行化疗或辅助性化疗。结果本组根治性膀胱切除术后尿道癌的发生率为6.1%,手术过程顺利。1例出现切口感染,经治疗后愈合。随访8~60个月,1例出现全身骨转移,1例出现双侧腹股沟淋巴结转移(经淋巴结活检证实),另4例未发现远处转移。结论根治性膀胱切除术后继发尿道癌发生率较低。尿道血性分泌物及肉眼血尿是尿道癌的主要临床表现。尿道膀胱镜检查是诊断尿道癌的重要手段,活检能够明确诊断,利用输尿管镜能提高活检的阳性率。CT和MR能明确肿瘤浸润的深度,并明确有无腹股沟及盆腔淋巴结的转移。全尿道切除术辅助化疗能提高膀胱癌行根治性膀胱切除术后继发尿道癌的生存期。     

膀胱癌根治性膀胱切除术后的男性尿道移行上皮癌:是否需要预防性尿道切除

1975—1984年间,110例男性患者因膀胱癌行根治性膀胱全切术。15例已证实或可疑尿道受累,其中10例作预防性或治疗性尿道切除术。年龄50—75岁,由于高度怀疑尿道受累,6例尿道切除与膀胱全切同时或术后2个月内,但术后病理均术发现尿道肿瘤,3例随访3年仍无瘤生存,余3例术后平均16个月时死于膀胱癌复发。4例因出现尿道受累作治疗性尿道切除术,分别于膀胱切除术后2、3、2、5年时施行。5例膀胱全切时发现前列腺尿道受累,因原发肿瘤已属晚期,未行尿道切除术,全部于术后平均6个月死于膀胱癌转移。     

膀胱移行上皮细胞癌行膀胱根治术后发生尿道癌10例分析

对膀胱移行上皮细胞癌行根治性膀胱切除尿流改道术67例中术后发生尿道癌10例进行分析,认为尿道癌的发生与原发膀胱癌累及前列腺尿道、膀胱内多发肿瘤、手术次数、膀胱肿瘤临床分期和分级有关。并对是否同时进行预防性全尿道切除术进行讨论。     

耻骨前尿道全切术

膀胱癌是泌尿系统最常见的肿瘤之一。由于尿路上皮癌具有多中心发生特点,膀胱癌患者行根治性膀胱全切术后尿道复发的概率为5％-10％。既往主张在膀胱全切术同时行预防性尿道切除,近年来随着原位膀胱技术的发展,目前仅限于肿瘤累及后尿道或膀胱颈口时行预防性尿道切除。尿道切除术传统上多采用经会阴途径,2010年6月-2016年7月,我们对8例男性膀胱癌患者行根治性膀胱切除术的同时行耻骨前尿道全切术,现报道如下。     

TUR术治疗原位新膀胱术后再发尿道癌

目的 探讨膀胱癌全膀胱切除原位新膀胱术后再发尿道癌的治疗方法.方法 膀胱癌行全膀胱切除原位新膀胱术患者89例,术后发生尿道癌5例(5.6%),再发尿道癌平均时间18(9～32)个月.5例患者病理分期为T1～T2.因复发性膀胱癌行全膀胱切除术4例,因膀胱多发癌行全膀胱切除术1例.采用乙状结肠原位新膀胱术3例,回肠原位新膀胱术2例.5例患者术后因排尿不畅(3例)、肉眼血尿(1例)、血性分泌物(1例)再次就诊.尿道镜检查发现尿道肿物位于前列腺部尿道2例、阴茎部尿道3例.肿物呈菜花状向尿道腔内生长,可见基底部,肿物直径1～3 cm.尿道镜活检报告均为尿道尿路上皮癌,病理分期为T1～T2.5例均行TUR术,术后病理报告为尿道非浸润性尿路上皮癌Ⅰ～Ⅱ级.术后辅以羟基喜树碱尿道灌注,每周1次,共6周.结果 5例TUR术后平均随访37(24～52)个月,控尿满意,血尿和血性分泌物均消失,尿细胞学检查均为阴性,尿道镜检查无阳性发现.肿瘤未见复发、转移.结论 膀胱癌膀胱全切术后再发尿道尿路上皮癌可以选择保全尿道的TUR术和尿道灌注治疗,疗效较满意且生活质量良好.     

前列腺癌合并膀胱癌4例分析

目的探讨前列腺癌合并膀胱癌的诊断和治疗。方法总结156例前列腺腺癌患者资料，对其中4例合并膀胱移行细胞癌的患者进行分析。结果4例前列腺腺癌患者均接受B超、尿镜检和膀胱镜检查，发现同时合并膀胱移行细胞癌。其中2例接受经尿道膀胱肿瘤电切术和双侧睾丸切除术；1例接受经尿道膀胱肿瘤电切术和药物去势；1例接受经尿道膀胱肿瘤电切术和耻骨后前列腺根治切除术。术后均接受膀胱灌注治疗。随访12。36个月，除1例膀胱癌复发接受再次电切手术外，其余均无肿瘤复发。结论有血尿、排尿刺激症状和长期吸烟史的前列腺癌患者以及准备行前列腺癌根治手术的患者应进行膀胱镜检查以除外合并膀胱肿瘤。     

比较经尿道膀胱肿瘤等离子电切术与传统开放膀胱部分切除术治疗非肌层浸润性膀胱癌的效果

目的比较经尿道膀胱肿瘤等离子电切术与传统开放膀胱部分切除术治疗非肌层浸润性膀胱癌的效果。方法将2016-12—2018-06间太康县人民医院收治的70例非肌层浸润性膀胱癌患者依据术式不同分为2组,各35例。A组采用传统开放膀胱部分切除术,B组采用经尿道膀胱肿瘤等离子电切术。比较2组术中出血量、手术时间及术后导尿管留置时间和并发症发生率。结果 B组术中出血量、手术时间及术后导尿管留置时间和并发症发生率等指标均优于A组,差异有统计学意义(P0.05)。结论与开放膀胱部分切除术相比,经尿道膀胱肿瘤等离子电切术治疗非肌层浸润性膀胱癌微创性佳,术后康复时间短、且并发症少,安全性高。     

膀胱全切术后继发尿道癌三例报告

膀胱癌行膀胱切术后继发尿道癌临床少见 ,我院 1990年 1月至 2 0 0 0年 11月行保留尿道的全膀胱切除手术 98例 ,其中 3例术后继发尿道癌 ,发生率 3%。资料与方法　本组 3例。男 2例 ,女 1例。年龄 48～ 6 2岁 ,平均 5 5岁。病史 2个月～ 1年。主要症状为间歇性无痛全程肉眼血尿     

男性尿道癌3例报告

目的探讨男性尿道癌临床特点和诊治措施。方法总结本院2000~2008年诊治的3例男性尿道癌的临床资料,并结合文献讨论。结果男性尿道鳞癌2例,移行细胞癌1例。1例尿道鳞癌行膀胱、前列腺、精囊、阴茎全切和盆腔淋巴结清扫术及回肠膀胱术,术后2年死于心肌梗死。1例尿道鳞癌行膀胱、前列腺、精囊、阴茎全切、耻骨部分切除和盆腔淋巴结清扫术以及回肠膀胱术,存活至今。1例尿道移行细胞癌行姑息性经尿道后尿道肿瘤电切和前列腺部分电切,术后半年患者死于心肺疾病。结论男性尿道癌以手术治疗为主,辅助化疗和放疗,其预后与肿瘤部位、临床分级和病理分级有关。远端尿道癌预后优于球膜部尿道癌。     

膀胱癌肉瘤诊疗体会(附3例报告)

目的:探讨膀胱癌肉瘤的诊断及治疗方法。方法:回顾性分析我院2005年~2012年收治的3例膀胱癌肉瘤患者的临床资料,3例患者均以全程无痛肉眼血尿为首发症状,伴排尿困难2例,尿频、尿急1例,膀胱镜检示肿瘤发生于膀胱左侧壁2例,膀胱顶底部1例。3例患者中1例行经尿道膀胱肿瘤电切术(TURBT),1例行全膀胱切除术+回肠膀胱术,1例行膀胱全切术+双侧输尿管皮肤造口术。结果:所有患者术后病理均证实为膀胱癌肉瘤,3例均为高级别。患者术后均获随访,随访时间10~36个月,1例术后10个月死亡,1例术后2年死亡。1例术后至今存活3年。结论:膀胱癌肉瘤是一种少见的高度恶性的膀胱肿瘤,根治性膀胱切除术是主要的治疗方式,术后放化疗效果均不理想,预后差。     

膀胱肿瘤行根治性膀胱切除时是否需同期行尿道切除的探讨

膀胱肿瘤是泌尿男生殖系统肿瘤中发病率占首位的肿瘤,治疗后容易复发或转移是其独特的生物学行为之一。在当前,对复发、多发、浸润性膀胱肿瘤,几乎公认根治性膀胱全切术为最佳的治疗方案。但在膀胱全切时是否需同期行尿道切除,目前学术界尚未达成共识。本文结合国内外文献报道加我们的临床体会,对膀胱全切术后出现尿道癌的发病率、高危因素、不同尿流改道方式以及男女性别差异等方面对尿道癌发生的影响进行探讨,对一旦发生尿道癌后的临床表现、早期诊断措施及治疗方式等并结合临床实践予以介绍,以期更进一步提高对此类疾病的早期诊断及合理治疗水平,达到提高患者生活质量、延长生存的目的。     

膀胱癌膀胱全切术后尿道复发的风险评估及对策

目的 探讨膀胱癌膀胱全切术后尿道复发的危险因素及处理方法。方法 回顾分析278例膀胱癌膀胱全切患者的临床资料，其中24例发生了尿道复发。运用cox’s多因素回归模型对影响复发的危险因素进行评价。结果 6例选择性尿道切除者无1例死于肿瘤；24例尿道复发者10例死于肿瘤转移。多因素分析表明前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤和原位癌是影响尿道复发的危险因素，相对危险度分别为1．573，1．532，1．360，1.337和1．213。结论 前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤或原位癌是预防性尿道切除术的指征。保留尿道的患者宜尽量行正位排尿的尿流改道术。     

A case of urethral recurrence found 15 years after radical cystectomy

PURPOSE: A case of a urethral recurrence found 15 years after radical cystectomy is reported. METHODS/RESULTS: A 78-year-old man, who had undergone radical cystectomy at age 63, presented with urethral bleeding and positive cytology in urethral washing. The urethra was surgically resected. Pathologic examination revealed transitional cell carcinoma located in the distal and mid portion of the penile urethra. CONCLUSION: Evidence suggested that urethral recurrence resulted from the implantation from the primary bladder tumor; in addition, the urethral neoplasm had scarcely grown in the penile urethra for 15 years.     

Urethral tumor recurrences after radical cystoprostatectomy: the case for primary cystoprostatourethrectomy?

Of 273 male patients who underwent radical cystoprostatectomy between 1967 and 1987, 22 were regarded as at risk for urethral recurrence. These patients underwent simultaneous primary urethrectomy or urethrectomy shortly after cystectomy because of the histology of the cystectomy specimen. Of the remaining 251 patients a urethral recurrence was observed in 23 (9.2%). A patient with a urethral recurrence originally had undergone an operation at another hospital. The first urethral tumor recurrence was observed in 1977 but between October 1987 and May 1988, 7 patients were treated for an initial or secondary urethral recurrence. This finding suggests that the rate of urethral recurrence increases with improved survival rates after cystoprostatectomy and longer followup of these patients. Of the 24 patients who had urethral recurrence 21 showed multifocal tumor growth in the primary cystectomy specimen and 2 had unifocal tumors. The original histological status in the patient treated elsewhere is not known. The data suggest that primary simultaneous urethrectomy should be performed in all patients undergoing cystoprostatectomy for multifocal bladder tumors. Patients who retain the urethra require regular and life-long washout cytology studies of the urethra for early diagnosis of recurrent urethral tumor.     

Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1,069 patients with 10-year followup

PURPOSE: Risk factors for upper tract recurrence following radical cystectomy for transitional cell carcinoma of the bladder are not yet well-defined. We reviewed our population of patients who underwent radical cystectomy to identify prognostic factors and clinical outcomes associated with upper tract recurrence. MATERIALS AND METHODS: From our prospective database of 1,359 patients who underwent radical cystectomy we identified 1,069 patients treated for transitional cell carcinoma of the bladder between January 1985 and December 2001. Univariate analysis was completed to determine factors predictive of upper tract recurrence. RESULTS: A total of 853 men and 216 women were followed for a median of 10.3 years (maximum 18.5). There were 27 (2.5%) upper tract recurrences diagnosed at a median of 3.3 years (range 0.4 to 9.3). Only urethral tumor involvement was predictive of upper tract recurrence. In men superficial transitional cell carcinoma of the prostatic urethra was associated with an increased risk of upper tract recurrence compared with prostatic stromal invasion or absence of prostatic transitional cell carcinoma (p <0.01). In women urethral transitional cell carcinoma was associated with an increased risk of upper tract recurrence (p = 0.01). Despite routine surveillance 78% of upper tract recurrence was detected after development of symptoms. Median survival following upper tract recurrence was 1.7 years (range 0.2 to 8.8). Detection of asymptomatic upper tract recurrence via surveillance did not predict lower nephroureterectomy tumor stage, absence of lymph node metastases or improved survival. CONCLUSIONS: Patients with bladder cancer are at lifelong risk for late oncological recurrence in the upper tract urothelium. Patients with evidence of tumor involvement within the urethra are at highest risk. Surveillance regimens frequently fail to detect tumors before symptoms develop. However, radical nephroureterectomy can provide prolonged survival.     

Urethral tumor recurrence following radical cystoprostatectomy--an indication for primary cystoprostato-urethrectomy?

A total of 273 male patients underwent radical cystoprostatectomy between 1967 and 1987, 22 of them being regarded as at risk for urethral tumor recurrence. In these 22 primary simultaneous urethrectomy was performed or urethrectomy followed shortly after cystectomy because of the histology of the cystectomy specimen. Of the remaining 251 patients, a urethral tumor recurrence was observed in 23 (9.2%). Another patient with a urethral recurrence had originally been operated on in another hospital. The first urethral tumor recurrence was observed in 1977, but between October 1987 and May 1988, 7 patients were treated for urethral recurrence or rerecurrence, suggesting that this problem will be recorded increasingly often with improved survival rates from the original bladder tumor and longer follow-up of these patients. In 21 of the 24 patients with recurrence, multifocal tumor growth (multiple primary tumors, multifocal carcinoma in situ, unifocal primary tumor with concomitant carcinoma in situ or severe dysplasia) was found in their primary cystectomy specimen. Two had unifocal tumors. The original histology of the patient operated on elsewhere is not known. The data suggest that primary simultaneous urethrectomy should be performed in all patients undergoing cystoprostatectomy for multifocal bladder tumors. All patients in whom the urethra is left in place need regular washout cytologies of the urethra for the rest of their lives to ensure early diagnosis of any urethral tumor recurrences.     

膀胱移行细胞癌行膀胱全切术后尿道再发肿瘤的原因及处理

目的 研究膀胱移行细胞癌行膀胱全切术后尿道再发肿瘤的原因及处理方法，进行提出预防及治疗措施，以降低尿道再发肿瘤的可能性。方法 回顾分析1978～1998年膀胱全切后尿道再发肿瘤19例。结果 尿道再发肿瘤占9%，均为男性。18例发生于后尿道，1例发生于前尿道，主要症状为尿道溢血。结论 再发原因除移行上皮肿瘤的多中心发生因素外，膀胱肿瘤已侵及前列腺及前列腺尿道的主要原因。“膀胱全切除”范围不够，残留前列腺及前列腺尿道以及膀胱切除时对肿瘤的挤压也是不容忽视的原因。少数病例也可经血行转移至前尿道。尿道全切术有替代后尿道切除术的趋势。     

Urethral recurrence following radical cystectomy

We reviewed the clinical courses of 86 men after radical cystoprostatectomy for transitional cell carcinoma of the bladder to determine who were at highest risk for urethral recurrence. We assessed patients for prostatic involvement as well as tumor extent in the bladder and distal ureters. Of the 30 patients with tumor in the prostate 11 (37%) suffered urethral recurrences. Of the 56 patients with all other types of tumor involvement patterns exclusive of disease in the prostate only 2 (4%) had recurrence. We recommend rigorous screening for transitional cell carcinoma of the prostate before cystectomy. Prophylactic urethrectomy is indicated for patients with prostatic involvement, while those without such involvement may be considered at low risk for urethral recurrence.     

Upper urinary tract recurrence following radical cystectomy for bladder cancer

AIM: The objective of this study was to analyze the clinicopathological features of upper urinary tract recurrence following radical cystectomy for bladder cancer. METHODS: Between 1995 and 2003, 583 patients underwent radical cystectomy and urinary diversion for bladder cancer at the authors' institution and the related hospitals. A retrospective review of patient records was carried out to evaluate characteristics of patients who underwent upper urinary tract recurrence after radical cystectomy. RESULTS: During the observation period (median, 41.5 months), 12 (2.1%) of the 583 patients had upper urinary tract recurrence. Of the 12 patients with upper urinary tract recurrence, there were multiple tumors in eight at the initial diagnosis of bladder cancer, and eight received transurethral resections two or more times before radical cystectomy. The median time to diagnosis of an upper urinary tract cancer after radical cystectomy was 29.5 months. When upper urinary tract recurrence was detected, five patients had metastatic diseases simultaneously, and two had bilateral upper urinary tract cancers. The cancer-specific survival in patients with upper urinary tract recurrence was significantly poorer than that in those without upper urinary tract recurrence. In addition, eight of the 12 patients (66.7%) died of disease progression within 3 years after the diagnosis of upper urinary tract cancer. CONCLUSIONS: These findings suggest that despite the low incidence of upper urinary tract recurrence following radical cystectomy, the prognosis of such patients was markedly poorer compared with that of those without upper urinary tract recurrence. Accordingly, intensive therapies should be considered when upper urinary tract recurrence is detected after radical cystectomy.     

Urethral tumor recurrence following cystectomy and urinary diversion: clinical and pathological characteristics in 768 male patients

PURPOSE: We evaluated the incidence and risks of urethral recurrence following radical cystectomy and urinary diversion in men with transitional cell carcinoma of the bladder. MATERIAL AND METHODS: Clinical and pathological results were evaluated in 768 consecutive male patients undergoing radical cystectomy with intent to cure for bladder cancer with a median followup 13 years, including 397 (51%) who underwent orthotopic urinary diversion with a median followup of 10 years and 371 (49%) who underwent cutaneous urinary diversion with a median followup of 19 years. Demographically and clinically these 2 groups were well matched with the only exception being longer median followup in the cutaneous group (p <0.001). Urethral recurrence was analyzed by univariate and multivariable analysis according to carcinoma in situ, tumor multifocality, pathological characteristics (tumor grade, stage and subgroup), the presence and extent of prostate tumor involvement (superficial vs stromal invasion) and the form of urinary diversion (cutaneous vs orthotopic). RESULTS: A total of 45 patients (6%) had urethral recurrence at a median of 2 years (range 0.2 to 13.6), including 16 (4%) with an orthotopic and 29 (8%) with a cutaneous form of urinary diversion. Carcinoma in situ and tumor multifocality were not significantly associated with an increased risk of urethral recurrence (p = 0.07 and 0.06, respectively). The presence of any (superficial and/or stromal invasion) prostatic tumor involvement was identified in 129 patients (17%). Prostate tumor involvement was associated with a significantly increased risk of urethral recurrence (p = 0.01). The estimated 5-year chance of urethral recurrence was 5% without any prostate involvement, increasing to 12% and 18% with superficial and invasive prostate involvement, respectively. Patients undergoing orthotopic diversion demonstrated a significantly lower risk of urethral recurrence compared with those undergoing cutaneous urinary diversion (p = 0.02). Patients without any prostate tumor involvement and orthotopic diversion (lowest risk group) demonstrated an estimated 4% year chance of urethral recurrence compared with a 24% chance in those with invasive prostate involvement undergoing cutaneous diversion (highest risk group). On multivariate analysis any prostate involvement (superficial and/or invasive) and urinary diversion form remained independent and significant predictors of urethral recurrence (p = 0.035 and 0.01, respectively). CONCLUSIONS: At long-term followup urethral tumor recurrence occurs in approximately 7% of men following cystectomy for bladder transitional cell carcinoma. Involvement of the prostate with tumor and the form of urinary diversion were significant and independent risk factors for urethral tumor recurrence. Patients undergoing orthotopic diversion have a lower incidence of urethral recurrence compared with those undergoing cutaneous diversion. Although prostate tumor involvement is a risk factor for urethral recurrence, it should not preclude orthotopic diversion, provided that intraoperative frozen section analysis of the urethral margin is without evidence of tumor.