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Tipps und Tricks der nerverhaltenden Zystektomie

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Zusammenfassung

Das Ziel der radikalen Zystektomie mit nachfolgender Harnableitung ist es, ein sicheres onkologisches Ergebnis mit einem zufrieden stellenden funktionellen Ergebnis zu kombinieren. Rezente Erkenntnisse zur Anatomie, Physiologie und Innervation der Beckenorgane haben zu einer modifizierten, nerverhaltenden Operationstechnik geführt. Eine Vielzahl von Studien konnten zeigen, dass das onkologische Ergebnis, insbesondere die Rate an Lokalrezidiven, nach nerverhaltender Zystektomie im Vergleich zur konventionellen Technik nicht erhöht ist. Eine nerverhaltende Zystektomietechnik ist für das funktionelle Ergebnis nach orthotopem Blasenersatz hinsichtlich des Kontinenzstatus und der erektilen Funktion von großer Bedeutung. Voraussetzungen für einen Nerverhalt sind fundierte anatomische Kenntnisse und eine subtile Operationstechnik. Neueste chirurgische Entwicklungen, wie die prostata- und samenblasenschonende Operationstechnik zeigen, dass es in Zukunft möglich sein wird, die untere Harntrakt-, aber auch die Sexualfunktion nach radikaler Zystektomie weitgehend wiederherzustellen.

Abstract

The aim of radical cystectomy with subsequent urinary diversion is to combine a safe oncological outcome with a satisfactory lower urinary tract function. Recent findings on the anatomy, physiology and nerve supply of the pelvis have resulted in a modified nerve-sparing cystectomy technique. A number of studies have shown that the oncological outcome is not compromised by such a technique; in particular the rate of local recurrences is not enhanced. Nerve-sparing cystectomy is of importance for the lower urinary tract function, including continence status after orthotopic bladder substitution and erectile function. Prerequisites for a nerve-sparing technique are a profound knowledge on the nerve supply of the pelvic organs and a subtle surgical technique. Recent surgical developments, for example in prostate and seminal vesicle sparing cystectomy techniques, indicate that it will be feasible to restore lower urinary tract and also sexual function after radical cystectomy and orthotopic bladder substitution.

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Authors and Affiliations

  1. Abteilung für Urologie und Andrologie, Ludwig-Boltzmann-Institut für Urologische Onkologie—Donauspital, Wien, Österreich

    S. Madersbacher

  2. Klinik für Urologie, Universität Bern—Inselspital, Bern, Schweiz

    W. Hochreiter & U. E. Studer

  3. Abteilung für Urologie und Andrologie im Donauspital, Langobardenstraße 122, 1220 , Wien, Österreich

    S. Madersbacher

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  1. S. Madersbacher
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  2. W. Hochreiter
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  3. U. E. Studer
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Correspondence to S. Madersbacher.

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Madersbacher, S., Hochreiter, W. & Studer, U.E. Tipps und Tricks der nerverhaltenden Zystektomie. Urologe [A] 43, 151–155 (2004). https://doi.org/10.1007/s00120-003-0498-x

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  • DOI: https://doi.org/10.1007/s00120-003-0498-x

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