Harnableitung und Rekonstruktion nach Zystektomie

Zusammenfassung

Kontinente Harnableitungen mit ausgeschalteten Darmschlingen sind derzeit bei Männern und Frauen das Verfahren der Wahl nach radikaler Zystektomie. Bei sorgfältig ausgewählten Patienten kann durch die Erschaffung einer Neoblase die Notwendigkeit eines äußeren Stomas verhindert und das Körperbild bewahrt werden, ohne die Tumorchirurgie zu kompromittieren. Der Patient muss ausführlich darüber in Kenntnis gesetzt werden, dass es eines hohen Maßes an Eigenengagement während des Rehabilitationsprozesses bedarf. Darüber hinaus sollte er ein gewisses Maß an Fingerfertigkeit besitzen, um im Fall der Fälle Selbstkatheterismus durchführen zu können.

Eine Tumorbeteiligung der Harnröhre verhindert den Einsatz einer orthotopen Neoblase. Ein kontinentes kutanes Reservoir bietet im Vergleich zum inkontinenten Ileumkonduit jedoch wesentliche Vorteile. Bei jenen Patienten, bei denen keine Art der kontinenten Ableitung infrage kommt, bleibt das Ileumkonduit weiterhin eine geeignete und zuverlässige Alternative.

Durch diese Fortschritte im Bereich der rekonstruktiven Chirurgie können Patienten die radikale Zystektomie in einem früheren Stadium des Blasentumors eher/leichter akzeptieren als erst im Rahmen der Second-Line-Therapie. Das kann das Outcome bei der Behandlung von Blasentumoren endgültig verbessern.

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