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Langzeitergebnisse der defunktionalisierten Blase nach Harnableitung

Long-term follow-up of the defunctionalized bladder after urinary diversion

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Zusammenfassung

Hintergrund

Die defunktionalisierte Blase ist eine seltene Entität. Wenige Studien haben die Morbidität der ausgeschalteten Blase untersucht. Retrospektiv wurden 9 Patienten nachgesorgt, bei denen die Blase nach supravesikaler Harnableitung in situ belassen worden war.

Material und Methoden

Im Zeitraum zwischen 1972 und 2008 identifizierten wir 9 Patienten aus unserer Klinik, bei denen eine supravesikale Harnableitung durchgeführt wurde, die Blase allerdings in situ belassen worden war. Indikationen waren u. a. Inkontinenz, eine neurogene Blase oder bilaterale Megaureteren. Zusätzlich erfolgte eine Literaturrecherche in PubMed, in der alle beschriebenen Fälle einer defunktionalisierten Blase von 1963–2007 ausgewertet wurden.

Ergebnisse

Häufige Komplikationen waren Pyozystitis (2/9), Blutungen (3/9) und Blasenspasmen (1/9). In 2 Fällen entwickelte sich ein Karzinom.

Schlussfolgerung

Ein Belassen der Blase nach supravesikaler Harnableitung erscheint in Abhängigkeit vom Alter des Patienten sinnvoll. Infekte und Blutungen sowie eine neoplastisches Potential erfordern eine regelmäßige Nachsorge.

Abstract

Purpose

The remaining bladder is an almost forgotten entity. We analyzed the literature and present patient data from our institution.

Methods and results

We studied patients at our institution who received a supravesical urinary diversion without concomitant cystectomy and reviewed the relevant literature to extract pros and cons for daily practice. This retrospective study was performed in nine patients at our institution (seven women and two men) with a median age of 40 years who underwent supravesical urinary diversion without concomitant cystectomy between 1972 and 2008 for benign conditions such as incontinence, neurogenic bladder or bilateral megaureters. The median follow-up was 10 years. Additionally we performed an extensive literature search where all such patients who underwent urinary diversion without concomitant cystectomy for benign indications were identified in different retrospective analyses by various authors.

Results

The most common complications were pyocystis (2/9), bleeding (3/9), and pain-related symptoms (1/9). Secondary carcinoma occurred in two cases. Secondary cystectomy was performed in one patient. In one patient the creation of a vesicovaginal fistula resolved the pyocystis completely.

Conclusions

The indication to leave the bladder in situ requires individual considerations. Due to potential complications and the progress in surgery with regards to maintaining sexual function a cystectomy should be offered to young patients. In the aging patient however a defunctionalized bladder can be discussed. The urologist should be aware of the potential complications and perform regular follow-up.

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  1. Klinik für Urologie und Kinderurologie, Helios-Klinikum, Universität Witten-Herdecke, Heusner Straße 40, 42283, Wuppertal, Deutschland

    F.-C. von Rundstedt, D. Lazica, A.S. Brandt, M.J. Mathers & S. Roth

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  1. F.-C. von Rundstedt
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  2. D. Lazica
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  3. A.S. Brandt
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  4. M.J. Mathers
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  5. S. Roth
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Correspondence to F.-C. von Rundstedt.

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von Rundstedt, FC., Lazica, D., Brandt, A. et al. Langzeitergebnisse der defunktionalisierten Blase nach Harnableitung. Urologe 49, 69–74 (2010). https://doi.org/10.1007/s00120-009-2144-8

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