膀胱癌における膜様部および陰茎部尿道病変 : 膀胱前立腺尿道摘出標本での検討

Abstract

18個の摘出標本で検討した。膀胱内のCIS(上皮内癌)の合併は13例で認められ, 単発4例, 多発14例であった。膀胱頸部病変は12例, 前立腺病変は7例で認められた。尿道病変は5例で見られ, CIS 2例, 形成異常3例であった。肉眼的尿道癌は尿道に認められなかった。尿道病変5例中4例はCISを伴う多発癌で, 膀胱頸部及び前立腺病変を合併していた。尿道形成異常の1例は単発膀胱癌で, 膀胱頸部や前立腺病変は認められなかった。前立腺病変のみが尿道病変の有意な危険因子である事が推計学的に明らかにされた

We studied 18 cystoprostatourethrectomy specimens, which were surgically removed for bladder cancer and step-sectioned in 0.5 cm thickness, to evaluate the relationship of the membranous and penile urethral lesions, with the multiplicity of bladder cancer, association of carcinoma in situ (CIS), bladder neck involvement, and prostatic involvement. Thirteen cases were associated with CIS. There were four solitary bladder cancers and 14 were with multiple cancers. Twelve cases were with bladder neck involvement and seven with prostatic involvement. There were five cases of urethral involvement; two cases of CIS and three with dysplasia. No macroscopic urethral cancers were detected in the urethra. Four of the five cases of urethral involvement had multiple cancers with CIS and were associated with bladder neck and prostatic involvement.One case of urethral dysplasia had solitary bladder cancer and neither bladder neck nor prostatic involvement were observed. Statistical analysis revealed that prostatic involvement was the only significant risk factor for urethral involvement. Our study shows that bladder cancer patients with prostatic involvement should be excluded from the candidates for bladder substitution utilizing the retained urethra. When a neobladder is indicated to bladder cancer patients, each case should be followed carefully for urethral recurrence.