Sekundäre Tumore nach Harnableitung

In this investigation the urinary diversions in 44 high-volume departments of urology in Germany since 1970 and all further diagnosed secondary tumors in these different types of urinary diversion have been analysed. The relation of the registered secondary tumors and the number of different urinary diversions allows the comparison of the tumor prevalence, in different forms of urinary diversions. The tumor risk in ureterosigmoidostomies ( 2,58% ) and ileocystoplasties ( 1,17% ) is significantly higher than in all other forms of urinary diversion. The difference between ureterosigmoidostomies and ileocystoplasties is not significant ( p=0,46 ). Furthermore our data confirm, that after ureterosigmoidostomies most tumors develop at the ureterointestinal anastomosis. In other forms of urinary diversion the secondary tumor develops more often at the anastomosis than in the intestinal part of the diversion, the difference being statistically not significant. The tumor risk in continent diversion via ileum, e.g. ilealneobladders ( 0,048% ) was not significantly higher than in incontinent ileal urinary diversion, e.g. ilealconduits ( 0,023% / p=0,09 ). This observation is not in accordance to literature published so far. The tumor risk in different urinary diversions via isolated intestinal segments were significantly different. Ileal diversions showed the lowest risk ( 0,031% ) followed by ileocoekal ( 0,25% ) and colonic diversions ( 0,4% ) – apart from ileocysstoplasies. Ileocystoplasties and ureterosigmoidostomies have the highest tumorrisk for secondary tumors. The tumor risk comparing continent colonic versus continent ileal diversions was significant ( p=0,001 ) – the comparison between ileal conduits and colonic conduits whereas showed no significance ( p=0,27 ). In accordance with the literature the difference between continent and incontinent urinary diversion was significant ( p=0,0009 ). The difference between ileal neobladders and ileocoecal neobladders was significant ( p=0,0045 ), the difference between ileal neobladders and ileocoecal pouches however was not significant ( p=0,84 ). It is difficult to draw a conclusion conderning this fact due to the small number of registered ileocoecal neobladders ( n=239 ) and ortotopic coecal neobladders ( n=70 ) in comparison to ileal neobladders ( n=4190 ) and ileocoecal pouches ( n=2181 ). Because of missing follow-up of the 17.758 patients an exact comparison of the tumor risk in urinary diversions and the colon tumor risk of the general population is not possible. On the other hand high tumor rates following ureterosigmoidostomies and ilealcystoplasties suggest an increased tumor risk compared to the general population. The high tumor risk following ileocystoplasties in contrast to the other ileal urinary diversions can not be explained by our data. Whether the higher tumor rates following ileocoecal or colonic diversions in comparison to ileal diversions is the result of a specifically increased tumor risk or just the result of the generally increased tumor incidence between colon and ileum can not be answered yet. The prevalence of secondary tumor in ileal neobladders and ileal conduits was so low suggesting no increased risk to the general population. Our data lead to specific recommendations for follow-up investigations in urinary diversion. Regular lifelong annual endoscopic controls from the fifth postoperative year on are recommended for ureoterosigmoidostomies and ilealcystoplasties. Routine endoscopie following ileal neobladders or ileal conduits is not necessary. Following ileal colonic pouches, ileal colonic neobladders or ortotopic colonic neobladders endoscopic control is mandatory in case of symptoms as haematuria, hydronephrosis or infection. In alternative regular endoscopic controls from the fifth postoperative year on can be taken into account.