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01.03.2015 | Leitthema

Kontinente Harnableitung nach vorderer Exenteration

verfasst von: Prof. Dr. R. Stein, M.G. Kamal, P. Rubenwolf, A. Großmann, C. Thomas, J.W. Thüroff

Erschienen in: Die Urologie | Ausgabe 3/2015

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Zusammenfassung

Hintergrund

Nach einer vorderen oder totalen Exenteration ist für die spätere Lebensqualität auch die Art der Harnableitung mit verantwortlich. Hierbei wird zwischen inkontinenten (Ureterokutaneostomie, Ileumconduit und Kolonconduit) und kontinenten Formen (kontinenter kutaner Pouch, orthotope Neoblase und rektales Reservoir) unterschieden.

Ergebnisse

Invasive Blasenkarzinome und fortgeschrittene gynäkologische Tumoren bzw. deren Lokalrezidive stellen die Hauptindikationen zur kontinenten Harnableitung bei Frauen dar. Beim nicht vorbestrahlten Blasenkarzinom stellen orthotope Neoblasen (vorausgesetzt, der Tumor infiltriert nicht Blasenhals oder Urethra) und rektale Harnableitungen eine Option dar. Bei den meist vorbestrahlten gynäkologischen Tumoren bzw. wenn eine postoperative Radiatio geplant ist, sollten nicht vorgeschädigte Darmsegmente (z. B. das Colon transversum) verwendet werden bzw. die Harnableitung außerhalb eines geplanten Strahlenfeldes liegen.

Schlussfolgerung

Vor- und Nachteile aller Formen der Harnableitung müssen (objektiv) mit den Patientinnen präoperativ besprochen werden. Insbesondere bei fortgeschrittenen gynäkologischen Tumoren sollte die Exenterationschirurgie in spezialisierten Zentren mit einem interdisziplinären Team (Gynäkologie, Urologie, Strahlentherapie und ggf. Abdominalchirurgie) erfolgen.

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Titel: Kontinente Harnableitung nach vorderer Exenteration
verfasst von: Prof. Dr. R. Stein
M.G. Kamal
P. Rubenwolf
A. Großmann
C. Thomas
J.W. Thüroff
Publikationsdatum: 01.03.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Die Urologie / Ausgabe 3/2015
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI: https://doi.org/10.1007/s00120-014-3684-0

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