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Pelvine Exenteration wegen gynäkologischer Tumoren

Urologische Versorgungsoptionen

Pelvic exenteration for gynecologic malignancies

Urological reconstructive armamentarium

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Bei gynäkologischen Rezidiv- oder persistierenden Tumoren nach Primärtherapie – in der Regel Zervixkarzinome – ist die vordere/totale Exenteratio derzeit die einzige verbleibende Therapieoption. Dabei nimmt die Erhaltung der Lebensqualität bzw. des Körperbildes für die häufig jungen Patientinnen eine vorrangige Position ein. Zur Rekonstruktion des unteren Harntraktes stehen inkontinente und kontinente Harnableitungen zur Verfügung. Zur Vermeidung von Komplikationen nach vorausgegangener Radiatio im kleinen Becken sollte dafür Darm außerhalb des Bestrahlungsfeldes verwendet und die Ureteren bis in einem vitalen, aktinisch nicht veränderten Bereich gekürzt werden. Im Langzeitverlauf können Harnableitungen mit einer signifikanten Rate an Komplikationen verbunden sein, diese sind meistens konservativ zu beherrschen. Zur Erhaltung der Nierenfunktion, zur Vermeidung metabolischer Störungen und zur frühzeitigen Erkennung von Zweitneoplasien sollten Patientinnen nach Harnableitung einer engmaschigen, lebenslangen Kontrolle unterzogen werden. Bei Einhaltung dieser Maßgaben können die Patientinnen in der Regel ein nahezu normales Leben ohne wesentliche Einbußen führen.

Abstract

Anterior/total pelvic exenteration is currently the only therapeutic option available for recurrent or persistent gynecologic malignancies (mostly cervical cancers) after primary therapy. At the same time, preserving quality of life and body image are primary goals for the patients, who are frequently young. The reconstructive armamentarium for the lower urinary tract includes incontinent and continent urinary diversion. To avoid complications arising from the use of previously irradiated bowel, it is advisable to isolate an intestinal segment outside the radiation field for urinary diversion. Likewise, the ureters should be shortened to a vital portion showing no actinic transformation. In the long term, urinary diversion can be associated with a significant rate of complications, although most of these are amenable to conservative treatment. To prevent renal damage and metabolic complications and for early diagnosis of secondary malignancy, patients need life-long close surveillance. Keeping up with these measures enables the patients to lead nearly normal lives with no loss in quality.

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  1. Urologische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55101, Mainz, Deutschland

    R. Gillitzer, C. Hampel & J.W. Thüroff

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  1. R. Gillitzer
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  2. C. Hampel
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  3. J.W. Thüroff
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Correspondence to R. Gillitzer.

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Gillitzer, R., Hampel, C. & Thüroff, J. Pelvine Exenteration wegen gynäkologischer Tumoren. Gynäkologe 40, 883–890 (2007). https://doi.org/10.1007/s00129-007-2066-8

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  • DOI: https://doi.org/10.1007/s00129-007-2066-8

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