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Kontinente Harnableitung nach vorderer Exenteration

Continent urinary diversion following anterior exenteration

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Zusammenfassung

Hintergrund

Nach einer vorderen oder totalen Exenteration ist für die spätere Lebensqualität auch die Art der Harnableitung mit verantwortlich. Hierbei wird zwischen inkontinenten (Ureterokutaneostomie, Ileumconduit und Kolonconduit) und kontinenten Formen (kontinenter kutaner Pouch, orthotope Neoblase und rektales Reservoir) unterschieden.

Ergebnisse

Invasive Blasenkarzinome und fortgeschrittene gynäkologische Tumoren bzw. deren Lokalrezidive stellen die Hauptindikationen zur kontinenten Harnableitung bei Frauen dar. Beim nicht vorbestrahlten Blasenkarzinom stellen orthotope Neoblasen (vorausgesetzt, der Tumor infiltriert nicht Blasenhals oder Urethra) und rektale Harnableitungen eine Option dar. Bei den meist vorbestrahlten gynäkologischen Tumoren bzw. wenn eine postoperative Radiatio geplant ist, sollten nicht vorgeschädigte Darmsegmente (z. B. das Colon transversum) verwendet werden bzw. die Harnableitung außerhalb eines geplanten Strahlenfeldes liegen.

Schlussfolgerung

Vor- und Nachteile aller Formen der Harnableitung müssen (objektiv) mit den Patientinnen präoperativ besprochen werden. Insbesondere bei fortgeschrittenen gynäkologischen Tumoren sollte die Exenterationschirurgie in spezialisierten Zentren mit einem interdisziplinären Team (Gynäkologie, Urologie, Strahlentherapie und ggf. Abdominalchirurgie) erfolgen.

Abstract

Background

Quality of life after anterior or total exenteration is determined, among other factors, by the type of urinary diversion. There are two different types of urinary diversion: incontinent diversion (ureterocutaneostomy, ileal conduit, and colonic conduit) and continent diversions (continent cutaneous pouch, orthotopic neobladder, and rectal reservoir).

Results

Invasive bladder cancer and advanced or recurrent gynecological tumors are the main indications for continent urinary diversion in women. In patients with non-irradiated bladder cancer, an orthotopic neobladder (except those with tumor invasion of the bladder neck or urethra) or a rectal reservoir is an option. In patients who had received preoperative radiotherapy, non-irradiated bowel segments should be used for urinary diversion (e.g., the transverse colon). In patients with planned postoperative radiation, the urinary diversion should be outside the radiation field.

Conclusion

Advantages and disadvantages of all types of urinary diversion should be objectively discussed with the patient. Especially exenteration for advanced or recurrent gynecological cancers should be performed in centers with a multidisciplinary team (gynecologist, urologist, radiotherapist, and in cases with complete exenteration the gastrointestinal surgeon).

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Stein, M.G. Kamal, P. Rubenwolf, A. Großmann, C. Thomas und J.W. Thüroff geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung Kinderurologie, Urologische Klinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeck Straße 1, 55131, Mainz, Deutschland

    R. Stein, P. Rubenwolf & A. Großmann

  2. Urologische Klinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

    R. Stein, M.G. Kamal, P. Rubenwolf, A. Großmann, C. Thomas & J.W. Thüroff

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  1. R. Stein
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Stein, R., Kamal, M., Rubenwolf, P. et al. Kontinente Harnableitung nach vorderer Exenteration. Urologe 54, 359–367 (2015). https://doi.org/10.1007/s00120-014-3684-0

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