Subscribe to RSS
DOI: 10.1055/s-0034-1367572
Nachsorge nach Blasenersatzoperationen[*]
Publication History
Publication Date:
05 June 2014 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00026982/201401/lookinside/thumbnails/10.1055-s-0034-1367572-1.jpg)
Zusammenfassung
Ein Blasenersatz wird zumeist nach radikaler Zystektomie wegen eines Urothelkarzinoms der Harnblase erforderlich. Neben der Tumornachsorge (lokales, urethrales und systemisches Rezidiv, Tumorauftreten im oberen Harntrakt) ist eine funktionelle Nachsorge der Harnableitung erforderlich. Die diesbezüglichen Leitlinienempfehlungen sind noch lückenhaft. Durch lange Kontaktzeit und große Oberfläche in kontinenten Pouches aus Darmsegmenten kann die Resorption von Harnbestandteilen zu Elektrolytstörungen und Azidosen führen. Entscheidend für die Kompensation ist die Nierenfunktion. Die Ausschaltung langstreckiger Ileumsegmente aus der Darmpassage kann zu Malabsorption von Vitamin B12 und Gallensäuren führen. Jeweils bis über 30 % der Langzeitüberlebenden nach Zystektomie mit kontinenten Ersatzblasen substituieren Bicarbonat und Vitamin B12. Besondere Aufmerksamkeit ist auch dem oberen Harntrakt, der Nierenfunktion und der Entwicklung von Sekundärmalignomen zu widmen. Sekundärmalignome treten gehäuft in Sigma-Rektum-Pouches, Blasenaugmentationen und Ersatzblasen mit Inkorporation von Kolonanteilen auf. In der Nachsorge ist es wichtig, die spezifischen Komplikationsmöglichkeiten der verschiedenen Harnableitungsformen zu berücksichtigen.
* Erstpublikation: Akt Urol 2013; 44: 55–67
-
Literatur
- 1 Jentzmik F, Schrader AJ, de Petriconi R et al. The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome. World J Urol 2012; 30: 733-739
- 2 Studer UE, Burkhard FC, Schumacher M et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute – lessons to be learned. J Urol 2006; 176: 161-166
- 3 Mathers MJ, Zumbe J, Wyler S et al. Is there evidence for a multidisciplinary follow-up after urological cancer? An evaluation of subsequent cancers. World J Urol 2008; 26: 251-256
- 4 Ghoneim MA, Abdel-Latif M, el-Mekresh M et al. Radical cystectomy for carcinoma of the bladder: 2720 consecutive cases 5 years later. J Urol 2008; 180: 121-127
- 5 Bochner BH, Montie JE, Lee CT. Follow-up strategies and management of recurrence in urologic oncology bladder cancer: invasive bladder cancer. Urol Clin North Am 2003; 30: 777-789
- 6 Malkowicz SB, van Poppel H, Mickisch G et al. Muscle-invasive urothelial carcinoma of the bladder. Urology 2007; 69 (Suppl. 01) 3-16
- 7 Sanderson KM, Cai J, Miranda G et al. Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1,069 patients with 10-year followup. J Urol 2007; 177: 2088-2094
- 8 Stenzl A, Bartsch G, Rogatsch H. The remnant urothelium after reconstructive bladder surgery. Eur Urol 2002; 41: 124-131
- 9 Freeman JA, Tarter TA, Esrig D et al. Urethral recurrence in patients with orthotopic ileal neobladders. J Urol 1996; 156: 1615-1619
- 10 Nieder AM, Sved PD, Gomez P et al. Urethral recurrence after cystoprostatectomy: implications for urinary diversion and monitoring. Urology 2004; 64: 950-954
- 11 Stenzl A, Draxl H, Posch B et al. The risk of urethral tumors in female bladder cancer: can the urethra be used for orthotopic reconstruction of the lower urinary tract?. J Urol 1995; 153: 950-955
- 12 Stenzl A, Cowan NC, De Santis M et al. European Association of Urology (EAU). Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 2011; 59: 1009-1018
- 13 Stein R, Ziesel C, Frees S et al. Metabolische Langzeitprobleme bei der Harnableitung. Urologe 2012; 51: 507-514
- 14 Thüroff JW, Hampel C, Leicht W et al. Differenzialindikationen für verschiedene Harnableitungsformen. Urologe 2012; 51: 473-476
- 15 Poulsen AL, Steven K. Acid-base metabolism after bladder substitution with the ileal urethral Kock reservoir. Br J Urol 1996; 78: 47-53
- 16 McDougal WS. Metabolic complications of urinary intestinal diversion. J Urol 1992; 147: 1199-1208
- 17 Lim BL, Kelly AM. A meta-analysis on the utility of peripheral venous bloodgas analyses in exacerbations of chronic obstructive pulmonary disease in the emergency department. Eur J Emerg Med 2010; 17: 246-248
- 18 Mills RD, Studer UE. Metabolic consequences of continent urinary diversion. J Urol 1999; 161: 1057-1066
- 19 Stein R, Pflughaupt M, Gesenhofer M et al. Ureterosigmoidostomy and bone metabolism – is there a risk of osteoporosis after follow-up of 12–34 years?. J Urol 2003; 169: 164
- 20 Stein R, Fisch M, Andreas J et al. Whole-body potassium and bone mineral density up to 30 years after urinary diversion. Br J Urol 1998; 82: 798-803
- 21 Gerharz EW, Preece M, Duffy PG et al. Enterocystoplasty in childhood: a second look at the effect on growth. BJU Int 2003; 91: 79-83
- 22 Behrend C, Jeppesen PB, Mortensen PB. Vitamin B12 absorption after ileorectal anastomosis for Crohnʼs disease: effect of ileal resection and time span after surgery. Eur J Gastroenterol Hepatol 1995; 7: 397-400
- 23 Matsui U, Topoll B, Miller K et al. Metabolic long-term follow-up of the ileal neo-bladder. Eur Urol 1993; 24: 197-200
- 24 Fujisawa M, Gotoh A, Nakamura I et al. Long-term assessment of serum vitamin B12 concentrations in patients with various types of orthotopic intestinal neobladder. Urology 2000; 56: 236-240
- 25 Pfitzenmaier J, Lotz J, Faldum A et al. Metabolic evaluation of 94 patients 5 to 16 years after ileocecal pouch (Mainz pouch I) continent urinary diversion. J Urol 2003; 170: 1884-1887
- 26 Kuzminski AM, Del Giacco EJ, Allen RH et al. Effective treatment of cobalamin deficiency with oral cobalamin. Blood 1998; 92: 1191-1198
- 27 Pattni S, Walters JR. Recent advances in the understanding of bile acid malabsorption. Br Med Bull 2009; 92: 79-93
- 28 Borghede MK, Schlütter JM, Agnholt JS et al. Bile acid malabsorption investigated by selenium-75-homocholic acid taurine((75)SeHCAT) scans: causes and treatment responses to cholestyramine in 298 patients with chronic watery diarrhoea. Eur J Intern Med 2011; 22: 137-140
- 29 Fisch M, Wammack R, Spies F et al. Ileocecal valve reconstruction during continent urinary diversion. J Urol 1994; 151: 861-865
- 30 Wiesner C, Bonfig R, Stein R et al. Continent cutaneous urinary diversion: long-term follow-up of more than 800 patients with ileocecal reservoirs. World J Urol 2006; 24: 315-318
- 31 Madersbacher S, Schmidt J, Eberle JM et al. Long-term outcome of ileal conduit diversion. J Urol 2003; 169: 985-990
- 32 Steven K, Poulsen AL. The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol 2000; 164: 288-295
- 33 Lee KS, Montie JE, Dunn RL et al. Hautmann and Studer orthotopic neobladders: a contemporary experience. J Urol 2003; 169: 2188-2191
- 34 Helal M, Pow-Sang J, Sanford E et al. Direct (nontunneled) ureterocolonic reimplantation in association with continent reservoirs. J Urol 1993; 150: 835-837
- 35 Studer UE, Danuser H, Thalmann GN et al. Antireflux nipples or afferent tubular segments in 70 patients with ileal low pressure bladder substitutes: long-term results of a prospective randomized trial. J Urol 1996; 156: 1913-1917
- 36 Wiesner C, Pahernik S, Stein R et al. Long-term follow-up of submucosal tunnel and serosalined extramural tunnel ureter implantation in ileocaecal continent cutaneous urinary diversion (Mainz pouch I). BJU Int 2007; 100: 633-637
- 37 Waldner M, Hertle L, Roth S. Ileal ureteral substitution in reconstructive urological surgery: is an antireflux procedure necessary?. J Urol 1999; 162: 323-326
- 38 Roth S, van Ahlen H, Semjonow A et al. Does the success of ureterointestinal implantation in orthotopic bladder substitution depend more on surgeon level of experience or choice of technique?. J Urol 1997; 157: 56-60
- 39 Roth S, Weining C, Hertle L. Simplified uretero-intestinal implantation in continent cutaneous urinary diversion using ileovalvular segment as afferent loop and appendix as continent outlet. J Urol 1996; 155: 1200-1205
- 40 Shigemura K, Yamanaka N, Imanishi O et al. Wallace direct versus anti-reflux Le Duc ureteroileal anastomosis: comparative analysis in modified Studer orthotopic neobladder reconstruction. Int J Urol 2012; 19: 49-53
- 41 Wammack R, Wricke C, Hohenfellner R. Long-term results of ileocecal continent urinary diversion in patients treated with and without previous pelvic irradiation. J Urol 2002; 167: 2058-2062
- 42 Kälble T, Hofmann I, Riedmiller H et al. Tumor growth in urinary diversion: a multicenter analysis. Eur Urol 2011; 60: 1081-1086
- 43 Tollefson MK, Elliott DS, Zincke H et al. Long-term outcome of ureterosigmoidostomy: an analysis of patients with > 10 years follow-up. BJU Int 2010; 105: 860-863
- 44 Ali-El-Dein B, El-Tabey N, Abdel-Latif M et al. Late uro-ileal cancer after incorporation of ileum into the urinary tract. J Urol 2002; 167: 84-88
- 45 Berberian JP, Goeman L, Allory Y et al. Adenocarcinoma of ileal neobladder 20 years after cystectomy. Urology 2006; 68: 1343
- 46 Vergho D, Kocot A, Bauer C et al. Das inkompetente Nabelstoma. Urologe 2012; 51: 485-493
- 47 Müller-Plathe O. Säure-Basen-Gleichgewicht und Blutgase. In: Thomas L, Hrsg. Labor und Diagnose. 7. Aufl. Frankfurt: TH-Books; 2008: 468-479