Dergiler / Üroloji Bülteni / 1999 / Cilt: 10 - Sayı: 3
Radikal sistektomi sırasında eşzamanlı üretrektomi ne kadar gerekli?
- Dergi
- Üroloji Bülteni
- Sayfa
- 146–150
- DOI
- —
Özet
invazif mesane tumoru nedeniyle radikal sistektomi gegiren. olgulardaki uretral rekurrens oranlannin, es zamahli uretrektominin gerekliliginin ve risk tasiyan olgularda yikama suyu sitolojisinin tanisal degerinin arastinlmasi. Hastalarve Ydnfem.-Qalismaya radikal sistektomi yapilan 146 olgu alindi. Uretral rekurrens yonunden risk tasiyan 50 plgu ek olarak uretra yikama suyu sitolojileriyle de izlendi. Bulgular: Radikal sistektomi sonrasmda turn olgularda uretral rekurrens orani % 2.7 (4/146) iken, uretral rekurrens yonunden risk tasiyan olgularda bu oran % 8 (4/50) idi. Prt|statik stromal invazyon % 25 (2/8) rekurrens oraniyla en onemli risk faktoruydu. Ameliyat oncesinde yapilan transuretral biyopsilerde 7 olguda prostatik uretral invazyon saptanirken, transuretral biyopsilerin prostatik stromal invazyonu gostermedeki duyarliligi ve ozgullugu, sirasiyla, % 87.5 ve % 97.6 olarak bulundu. Uretral rekurrens gosteren 4 olgudan 3'u semptomatik rekurrensler ortaya gikmadan once uretral yikama sjyu sitolojisi ile tanindi. Uretral yikama suyu sitolojisi ile tani konan 3 olgudan 2'si, uretrektomi ve uc kur Kombine kemoterapi sonrasindaki ortalama 30 aylik izlem suresinde hastaliksiz olarak sagdi. Sonug: Bu galismanin bulgulan, turn radikal sistektomi olgularmda es zamanli uretrektomiye gerek olmadigmi ve uretra yikama suyu sitolojisinin radikal sistektomi sonrasmda uretral rekurrensleri gostermede etkin bir'tani yontemi oldugunu du§undurmektedir.
Abstract
How Much Necessary Is Synchronous Urethrectomy During Radical Cystectomy ?-Objective: To evaluate urethra! recurrence rates, review indications for simultaneous urethrectomy and clarify diagnostic value of urethra! wash cytology for urethra! recurrences in high risk -patients after radical cystectomy for invasive bladder cancer. Patients and Methods: A total of 146 patients who underwent radical cystectomy were included. Urethra! wash cytologies were obtained in addition to routine followup measures in 50 high risk patients for urethra! recurrences. Results: While the overall urethra! recurrence rate after radical cystectomy was 2.7 % (4/246), this figure increased to 8 % (4/50) in cases with risk factors. The most prominent risk factor was prostatic stromal invasion that resulted in urethra! recurrences in 25 % of the patients (2/8). Transurethral prostatic biopsies before cystectomy revealed stromal invasion in 7 cases that rendered sensitivity and specificity rates of 87.5 % and 97.6 %, respectively, for transurethral biopsies in the diagnosis of prostatic invasion. Three of 4 urethra! recurrences were correctly diagnosed with urethra! ivash cytologies prior to symptomatic involvement. In a mean follow-up of'30 months, 2 of 3 cases diagnosed by means of urethra! wash cytologies were alive with no evidence of disease after urethrectomy and three courses of combined chemotherapy. Conclusion: Data obtained in the present study suggest that simultaneous urethrectomy with radical cystectomy is not necessary in all cases of invasive bladder cancer and urethra! wash cytology is an effective diagnostic method for early detection of urethra! recurrences after cystectomy.