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Nachsorge – Konsequenzen der Harnableitung nach Harnblasenkarzinom

Follow-up care – consequences of urinary diversion after bladder cancer

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Zusammenfassung

Die radikale Zystektomie stellt den Therapiestandard bei muskelinvasivem Karzinom der Harnblase dar. Als Harnableitung rücken kontinente Ersatzblasen aus Dünn- und Dickdarm immer mehr in den Vordergrund. Die Nachsorge sollte somit mehrere Schwerpunkte haben: Postoperativ bedarf es zunächst einer funktionellen Nachsorge der Harnableitung hinsichtlich Stenosen, Entleerungsstörungen oder Inkontinenz. Früh rückt dann die onkologische Nachsorge in den Fokus zur Früherkennung von lokalen, ggf. urethralen, urothelialen oder systemischen Rezidiven. Neuere Daten erlauben dazu eine Konzentration auf die ersten 3 postoperativen Jahre, da hier 90% der Rezidive auftreten. Langfristig kommen metabolische Aspekte hinzu wie Vitamin-B12- und Gallensäuremangel, Azidose und Störungen im Kalziumstoffwechsel. In der Nachsorge ist es wichtig, die spezifischen Komplikationsmöglichkeiten der verschiedenen Harnableitungsformen zu berücksichtigen. Einheitliche Leitlinienempfehlungen zu diesen Bereichen fehlen leider bislang oder sind lückenhaft.

Abstract

Radical cystectomy is the standard of care for muscle-invasive bladder cancer. Continent urinary diversions utilizing both small and large bowel are becoming more prominent: therefore, the postoperative follow-up has to focus on different aspects. In the first instance after radical cystectomy functional issues with respect to potential stenosis, post-void residual urine and micturition disorders are important. In the early phase the oncological follow-up aims to detect local, urethral and systemic recurrences and new data show the importance of the first 3 years after surgery. Long-term follow-up focuses on metabolic aspects, such as cobalamin or bile acid deficits, acidosis and disorders of calcium and bone metabolism. Follow-up care should consider specific complications of different types of urinary diversions; however to date standardized follow-up guidelines are lacking.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Degener, S. Roth, M.J. Mathers und B. Ubrig geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM), Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland

    S. Degener & S. Roth

  2. PandaMED Remscheid, Urologische Kooperationspraxis der Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Remscheid, Deutschland

    M.J. Mathers

  3. Klinik für Urologie, Augusta-Kranken-Anstalt, Bochum, Deutschland

    B. Ubrig

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  1. S. Degener
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  2. S. Roth
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  3. M.J. Mathers
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  4. B. Ubrig
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Correspondence to S. Degener.

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Degener, S., Roth, S., Mathers, M. et al. Nachsorge – Konsequenzen der Harnableitung nach Harnblasenkarzinom. Urologe 53, 253–264 (2014). https://doi.org/10.1007/s00120-013-3376-1

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