Blasenkarzinom − Komplikationen der Harnableitung

ZUSAMMENFASSUNG

Auch heute noch stellt die radikale Zystektomie mit Anlage einer Harnableitung einen der komplikationsträchtigsten Eingriffe in der Uro-Onkologie dar. Insbesondere im Langzeitverlauf, aber auch perioperativ spielen dabei durch die Harnableitung bedingte Probleme eine wesentliche Rolle.

Perioperativ stehen dabei im Wesentlichen gastrointestinale Probleme wie etwa ein Ileus, aber auch Infekte und frühe Komplikationen der unterschiedlichen Anastomosen im Vordergrund. Während ein Ileus ebenso wie perioperative Infekte i. d. R. medikamentös behandelt werden können, erfordern Insuffizienzen der intestinalen Anastomose regelhaft und Insuffizienzen der ureterointestinalen Anastomosen häufig operative Revisionen.

Im Langzeitverlauf können Narbenbildungen zu chronischen Harnabflussbehinderungen und bei kontinenten Harnableitungen zur Steinbildung führen und ebenso wie parastomale Hernien weitere Therapien erforderlich machen. Funktionelle Darmprobleme können die Lebensqualität der Patienten nachhaltig beeinflussen.

Durch eine verbesserte Vorbereitung präoperativ und die begleitenden Maßnahmen während des stationären Aufenthalts können nicht operationsbedingte Komplikationen signifikant reduziert werden.

Die Zystektomie mit der therapieassoziierten Morbidität ist ein Paradebeispiel für eine zentrumsbasierte Operation um Komplikationen sowohl perioperativ als auch im weiteren Follow-up zu reduzieren.

ABSTRACT

Even today, radical cystectomy with urinary diversion is one of the most complicated procedures in uro-oncology. Particularly in the long-term course, but also perioperatively, problems caused by urinary diversion play a significant role. Perioperatively, gastrointestinal problems such as an ileus, but also infections and early complications of the different anastomoses are most important. While ileus and perioperative infections can usually be treated conservatively, failure of the intestinal or ureteroileal anastomoses require regular surgical revisions. In the long-term follow-up, scarring can lead to chronic obstruction of urinary flow and, in the case of continental urinary diversions, to stone formation. These complications, as well as parastomal hernias in patients with poor conduits, may require further therapy. Functional bowel disorders may impair patients’ quality of life significantly.

Improved preoperative preparation and accompanying measures during the inpatient stay can significantly reduce non-surgical complications.

Cystectomy with therapy-associated morbidity is a classical example of when surgery must be performed at specialised centers to reduce complications perioperatively as well as in follow-up.

Schlüsselwörter

Harnblasenkarzinom - radikale Zystektomie - Harnableitung - Komplikation

Keywords

Bladder cancer - radical cystectomy - urinary diversion - complication

Publication History

Received: 08 March 2020

Accepted: 30 March 2020

Article published online:
29 April 2021

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