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Organ- und Funktionserhalt beim Urethralkarzinom

Organ and function preservation in urethral cancer

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Zusammenfassung

Urethralkarzinome sind seltene maligne Tumoren, die Männer genauso wie Frauen betreffen können. Die Histologie dieser Tumoren ist uneinheitlich, es finden sich Urothelkarzinome, Plattenepithelkarzinome und Adenokarzinome.

Verschiedene klinische Faktoren definieren die Prognose, wobei über alle Stadien das 1- und 5-Jahres-Überleben mit 75 und 54 % angegeben wird. Die Therapie ist beim lokal begrenzten Tumor eine chirurgische, wobei ein Organ- und Funktionserhalt möglich ist, wenn in der intraoperativen Schnellschnittdiagnostik eine R0-Situation erreicht werden kann. Beim Mann kann dabei allerdings die Anlage einer perinealen Urethrostomie notwendig werden, und bei Frauen geht eine partielle Resektion der Urethra über eine Strecke > 2 cm mit einem hohen Risiko einer nachfolgenden Inkontinenz einher.

Bei ausgedehnten oder proximal gelgenen Tumoren kann eine komplette Urethrektomie mit supravesikaler Harnableitung notwendig werden, gegebenenfalls nach neoadjuvanter (Radio-)Chemotherpie.

Abstract

Primary urethral carcinomas are rare tumors that can occur both in men and women. Histological patterns of these tumors are mixed, urothelial tumors occur as well as squamous cell tumors or adenocarcinomas.

There are different clinical factors that define clinical prognosis, and the 1- and 5-year cancer-free survival is 75% and 54%. Therapy of locally limited disease is surgical resection, and organ-preserving treatment is possible if negative frozen sections prove complete surgical resection. However, in men a perineal urethrostomy might be necessary, and in women there is a high risk of urinary incontinence if more than 2 cm of the distal urethra is resected.

In case of locally advanced tumors or tumors of the proximal urethra, a radical urethrectomy with supravesical urinrary diversion is necessary. In some cases neoadjuvant (radio-)chemotherapy may be an option.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Tritschler, K. Lellig, A. Roosen, A. Horng und C. Stief geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München, Marchioninistraße 15, 81377, München, Deutschland

    S. Tritschler, K. Lellig, A. Roosen & C. Stief

  2. Institut für Klinische Radiologie, Ludwig-Maximilians-Universität, München, München, Deutschland

    A. Horng

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  1. S. Tritschler
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  2. K. Lellig
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  3. A. Roosen
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  4. A. Horng
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  5. C. Stief
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Correspondence to S. Tritschler.

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Tritschler, S., Lellig, K., Roosen, A. et al. Organ- und Funktionserhalt beim Urethralkarzinom. Urologe 53, 1310–1315 (2014). https://doi.org/10.1007/s00120-014-3555-8

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  • DOI: https://doi.org/10.1007/s00120-014-3555-8

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