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. 2024 Oct;63(10):1050-1059.
doi: 10.1007/s00120-024-02401-8. Epub 2024 Aug 1.

[Follow-up after urinary diversion]

[Article in German]
Christopher Netsch  1 , Simon Filmar  2 , Sophia Hook  2 , Clemens Rosenbaum  2 , Andreas J Gross  2 , Benedikt Becker  2
Affiliations

[Follow-up after urinary diversion]

[Article in German]
Christopher Netsch et al. Urologie. 2024 Oct.

Abstract
in English, German

Radical cystectomy is currently the standard of care for muscle-invasive bladder cancer. Different parts of the small and large intestines can be utilized for continent and incontinent urinary diversion. The postoperative follow-up after urinary diversion should consider functional, metabolic and oncological aspects. The functional follow-up of (continent) urinary diversion includes stenosis, emptying disorders or incontinence. The oncological follow-up should focus on the detection of local, urethral and upper tract recurrences as well as distant metastases. As 90% of the tumor recurrences occur during the first 3 years, a close follow-up should be carried out during this period. Metabolic disturbances, such as vitamin B12 and bile acid deficits, acidosis and disorders of calcium metabolism can also occur during long-term follow-up. The metabolic follow-up should consider the metabolic consequences of the parts of the intestines utilized for the urinary diversion.

Die radikale Zystektomie stellt derzeit die Standardtherapie beim muskelinvasiven Harnblasenkarzinom dar. Als Harnableitung können für inkontinente und kontinente Formen unterschiedliche Anteile des Dünn- und Dickdarms verwendet werden. Die postoperative Nachsorge sollte funktionelle, metabolische und onkologische Gesichtspunkte berücksichtigen. Unter die funktionelle Nachsorge fallen bei der (kontinenten) Harnableitung beispielsweise Stenosen, Entleerungsstörungen oder Inkontinenz. Bei der onkologischen Nachsorge liegt der Fokus auf der Erkennung von Lokalrezidiven, Urethrarezidiven, Rezidiven des oberen Harntraktes und von Fernmetastasen. Da 90 % der Rezidive innerhalb der ersten 3 Jahre auftreten, sollten in diesem Zeitraum engmaschige Kontrollen durchgeführt werden. Metabolische Störungen wie Vitamin‑B12- und Gallensäuremangel, Azidose sowie Störungen im Kalziumstoffwechsel können im langfristigen Verlauf dazukommen. In der metabolischen Nachsorge sollten die metabolischen Konsequenzen der jeweils verwendeten Darmanteile bei der Harnableitung berücksichtigt werden.

Keywords: Complications; Cystectomy; Distant metastases; Recurrence; Urinary bladder neoplasms.

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References

Literatur

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