Skip to main content
SpringerLink
Log in

Komplikationen und deren Management nach Harnableitung

Complications and their management after urinary diversion

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Das Harnblasenkarzinom ist keine seltene Erkrankung. An einem invasiven Harnblasentumor erkranken in Deutschland im Jahr 2014 voraussichtlich 11.900 Männer und 4500 Frauen. Die Zystektomie, die insbesondere bei muskelinvasiven Harnblasenkarzinomen eingesetzt wird, erfordert eine Harnableitung.

Fragestellung

Die Darstellung von Komplikationen der Harnableitungen und deren Management werden aufgeführt.

Methode

Anhand einer selektiven Literaturrecherche in PubMed sowie eigener klinischer Erfahrung erläutern die Autoren die Optionen der Harnableitung sowie deren Management.

Ergebnisse

Bei kurativer Intention wird der kontinente orthotope Harnblasenersatz bevorzugt. Beim heterotopen Harnblasenersatz wird häufig ein Reservoir aus einem Ileum- oder Ileozäkalsegment gebildet. Die inkontinente kutane Harnableitung erfolgt meist in palliativer Absicht. Die vorliegende Arbeit zeigt die individuellen Früh- und Spätkomplikationen, die peri-/postoperative Mortalität sowie das Management dieser Patienten.

Schlussfolgerung

Nach einer Zystektomie stehen diverse Harnableitungsverfahren zur Verfügung, die teilweise in kurativer oder palliativer Intention eingesetzt werden können. Entscheidend für den Erfolg und die langfristige Zufriedenheit mit der Harnableitung ist die richtige Indikationsstellung.

Abstract

Background

Bladder cancer is a common disease. It is predicted that 11,900 men and 4,500 women in Germany will be diagnosed with invasive bladder cancer in 2014. The cystectomy, which is standard treatment in muscle-invasive bladder cancer, requires urinary diversion.

Purpose

The goal of this article is to present the complications associated with urinary diversions and their management.

Methods

Based on a selective literature search in PubMed and our own clinical experience, the options for urinary diversion and their management are discussed.

Results

In patients treated with curative intent, orthotopic bladder replacement is preferred. In patients with palliative intent, incontinent cutaneous urinary diversion is commonly used. The present work shows the variety of early and late complications, peri-/postoperative mortality, and the management of these patients.

Conclusion

After cystectomy, various methods for urinary diversion are available, which can be used in curative and/or palliative intent. Crucial to the success and the long-term satisfaction of the patients is selection of the right urinary diversion method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. RKI (2013) Krebs in Deutschland 2009/2010, 9. Ausgabe. Robert Koch-Institut (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (Hrsg), Berlin

  2. Konety BR, Joslyn SA, O’Donnell MA (2003) Extent of pelvic lymphadenectomy and its impact on outcome in patients diagnosed with bladder cancer: analysis of data from the Surveillance, Epidemiology and End Results Program data base. J Urol 169(3):946–950

    Article  PubMed  Google Scholar 

  3. Hautmann RE, Miller K, Steiner U, Wenderoth U (1993) The ileal neobladder: 6 years of experience with more than 200 patients. J Urol 150:40–45

    CAS  PubMed  Google Scholar 

  4. Hautmann RE, Petriconi RC de, Volkmer BG (2011) 25 years of experience with 1000 neobladders: long-term complications. J Urol 185:2207–2212

    Article  PubMed  Google Scholar 

  5. Shabsigh R, Korets R, Vora KC et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55:164

    Article  PubMed  Google Scholar 

  6. Melchior H, Spehr CH, Knop I et al (1988) Harnableitung nach radikaler Zystektomie: Ileum-Conduit oder Ileum-Ersatz- blase? Urologe A 27:158–163

    CAS  PubMed  Google Scholar 

  7. Hashad MM, Atta M, Elabbady A et al (2012) Safety of no bowel preparation before ileal urinary diversion. BJU Int 110(11 Pt C)

  8. Abe T, Takada N, Shinohara N et al (2013) Comparison of 90-day complications between ileal conduit and neobladder reconstruction after radical cystectomy: a retrospective multi-institutional study in Japan. Int J Urol

  9. Hautmann RE, Volkmer BG, Schumacher MC et al (2006) Long-term results of standard procedures in urology: the ileal neobladder. World J Urol 24(3):305–314

    Article  PubMed  Google Scholar 

  10. Ali-el-Dein B, Shaaban AA, Abu-Eideh RH et al (2008) Surgical complications following radical cystectomy and orthotopic neobladders in women. J Urol 180:206

    Article  PubMed  Google Scholar 

  11. Austen M, Kalble T (2004) Secondary malignancies in different forms of urinary diversion using isolated gut. J Urol 172:831–838

    Article  CAS  PubMed  Google Scholar 

  12. Pantuck AJ, Han KR, Perrotti M et al (2000) Ureteroenteric anastomosis in continent urinary diversion: long-term results and complications of direct versus nonrefluxing techniques. J Urol 163:450–455

    Article  CAS  PubMed  Google Scholar 

  13. Pagano S, Ruggeri P, Rovellini P, Bottanelli A (2005) The anterior ileal conduit: results of 100 consecutive cases. J Urol 174:959–962

    Article  PubMed  Google Scholar 

  14. MacGregor PS, Montie JE, Straffon RA (1987) Cutaneous ureterostomy as palliative diversion in adults with malignancy. Urology 30(1):31–34

    Article  CAS  PubMed  Google Scholar 

  15. Toyoda Y (1977) A new technique for catheterless cutaneous ureterostomy. J Urol 117(3):276–278

    CAS  PubMed  Google Scholar 

  16. Lodde M, Pycha A, Palermo S et al (2005) Uretero-ureterocutaneostomy (wrapped by omentum). BJU Int 95:371–373

    Article  PubMed  Google Scholar 

  17. Wiesner C, Pahernik S, Stein R et al (2007) Long-term follow-up of submucosal tunnel and serosa-lined extramural tunnel ureter implantation in ileocaecal continent cutaneous urinary diversion (Mainz pouch I). BJU Int 100(3):633–637

    Article  PubMed  Google Scholar 

  18. Kulkarni JN, Pramesh CS, Rathi S, Pantvaidya GH (2003) Long-term results of othotopic neobladder reconstruction after radical cystectomy. BJU Int 91:485–488

    Article  CAS  PubMed  Google Scholar 

  19. Pagano F, Bassi P, Galetti TP et al (1991) Results of contemporary radical cystectomy for invasive bladder cancer: a clinicopathological study with an emphasis on the inadequacy of the tumor, nodes and metastases classification. J Urol 145:45–50

    CAS  PubMed  Google Scholar 

  20. Roghmann F, Trinh QD, Braun K et al (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 21(2):143–149

    Article  PubMed  Google Scholar 

  21. Mansson W, Davidsson T, Konyves J et al (2003) Continent urinary tract reconstruction – the lund experience. Br J Urol 92:271–276

    Article  CAS  Google Scholar 

  22. May M, Fuhrer S, Braun KP et al (2007) Results from three municipal hospitals regarding radical cystectomy on elderly patients. Int Braz J Urol 33(6):764–773

    Article  PubMed  Google Scholar 

  23. Hautmann R, Miller K, De Petriconi R, Wenderoth U (1992) Harnblasenneu- bildung mit der Ileumneoblase. Dtsch Ärztebl 89:320–323

  24. Chang SS, Baumgartner RG, Wells N et al (2002) Causes of increased hospital stay after radical cystectomy in a clinical pathway setting. J Urol 167(1):208–211

    Article  PubMed  Google Scholar 

  25. Steiner U, Miller K, Hautmann R (1994) Functional results and complications of the ileal neobladder in over 200 patients. Urologe A 33:53–57

    CAS  PubMed  Google Scholar 

  26. Parekh DJ, Clark T, O ́Connor J et al (2002) Orthotopic neobladder following radical cystectomy in patients with high perioperative risk and co-morbid medical conditions. J Urol 168:2454–2456

    Article  PubMed  Google Scholar 

  27. Soulie M, Thoulouzan M, Seguin P et al (2003) Sind die funktionellen Ergebnisse der Ileumneoblase nach Hautmann auch in kleineren Serien nachvollziehbar? Urologe A 42:250–254

    CAS  PubMed  Google Scholar 

  28. Perimenis P, Burkhard FC, Kessler TM et al (2004) Ileal orthotopic bladder substitute combined with an afferent tubular segment: long-term upper urinary tract changes and voiding pattern. Eur Urol 46:604–609

    Article  PubMed  Google Scholar 

  29. Wenderoth UK, Bachor R, Egghart G et al (1989) 3 Jahre Ileum-Neoblase – die ersten 108 Patienten. Urologe A 28:204–208

    CAS  PubMed  Google Scholar 

  30. Jentzmik F, Schrader AJ, Petriconi R de et al (2012) The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome. World J Urol 30(6):733–739

    Article  PubMed  Google Scholar 

  31. Studer UE, Burkhard FC, Schumacher M et al (2006) Twenty years experience with an ileal orthotopic low pressure bladder substitute: lessons to be learned. J Urol 176:161–166

    Article  PubMed  Google Scholar 

  32. Madersbacher S, Schmidt J, Eberle JM et al (2003) Long-term outcome of ileal conduit diversion. J Urol 169:985–990

    Article  PubMed  Google Scholar 

  33. Frazier HA, Robertson JE, Paulson DF (1992) Complications of radical cystectomy and urinary diversion: a retrospective review of 675 cases in 2 decades. J Urol 148:1401–1405

    CAS  PubMed  Google Scholar 

  34. Pycha A, Comploj E, Martini T et al (2008) Comparison of complications in three incontinent urinary diversions. Eur Urol 54(4):825–832

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Rogenhofer, S.C. Müller, T. Kälble geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland

    S. Rogenhofer & S.C. Müller

  2. Klinik für Urologie und Kinderurologie, Klinikum Fulda gAG, Fulda, Deutschland

    T. Kälble

Authors
  1. S. Rogenhofer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S.C. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Kälble
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Rogenhofer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rogenhofer, S., Müller, S. & Kälble, T. Komplikationen und deren Management nach Harnableitung. Urologe 53, 984–990 (2014). https://doi.org/10.1007/s00120-014-3501-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-014-3501-9

Schlüsselwörter

Keywords

Search

Navigation