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VERVANGBLAAS VERSUS BRICKER

VERVANGBLAAS VERSUS BRICKER. Dr. Kris Vekemans. Indicaties. BLAASCARCINOOM meest frequent TCC soms plaveiselcel Zeldzaam adenocarcinoom Schrompelblaas TBC Bilhariose Interstitiële cystitis Radiotherapie Endoxan Neurogene blaas Congenitaal bv valve bladder.

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VERVANGBLAAS VERSUS BRICKER

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  1. VERVANGBLAAS VERSUS BRICKER Dr. Kris Vekemans

  2. Indicaties • BLAASCARCINOOM • meest frequent TCC • soms plaveiselcel • Zeldzaam adenocarcinoom • Schrompelblaas • TBC • Bilhariose • Interstitiëlecystitis • Radiotherapie • Endoxan • Neurogene blaas • Congenitaal bv valve bladder

  3. Meestal kankerchirurgie • Eerst en vooral cure • Is het mogelijk van urethrasparend te werken? urethrectomie • Leeftijd! • Prostaat is deel van blaas • Zelfde epitheel • Prostaatkanker 20 % • Hysterectomie / appendectomie • Lymfeklierdissectie++

  4. Zeg geen “poliep” tegen een TUMOR

  5. EAU GuidelinesBca 2009 7.5 and 7.6 Conclusions and recommendations Cystectomy is the preferred curative treatment for T2-T4a, N0-NX,M0, and high risk NMIBC (3) (B) Radicalcystectomyincludesremoval of regionallymphnodes, the extent of which has not been sufficientlydefined(3) (B) Treatment is recommended at centers experienced in major types of diversion techniques and postoperative care (B)

  6. MANNELIJK BEKKEN

  7. VROUWELIJK BEKKEN

  8. Goede staging PET CT!

  9. Quid na cystecomie

  10. BRICKER

  11. CAMEY

  12. KOCH POUCH

  13. MAINZ II POUCH

  14. Studerpouch I

  15. II

  16. III

  17. IV

  18. HAUTMAN POUCH

  19. postoperatief • Pouchsonde • spoelen alle 2u • Fixeren • 14-15d / pouchografie • 2 uretercatheters 10-14d • Redon • Maagsonde • pijnpomp

  20. Complicaties postoperatief Koorts Lymfedrainage Ureterlek Paralytische ileus DVT/longembolen Pouchlek/ruptuur

  21. Complicaties laattijdig Pouchruptuur Obstructie tgvbriden Retentie Incontinentie Recidief tumor in loco metastasen

  22. Bricker versus Pouch • Leeftijd • Comorbiditeit • Vrouwen • Geen CIC • Stoma • Kankercontrole • Adjuvante CT • Geen incontinentie • Sexueel • Leeftijd • Normale NF • Mannen • CIC • Geen stoma/spiegel • Kankercontrole • Adjuvante CT • Nachtelijke incontinentie • Sexueel

  23. Teamwork

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