{"id":18298,"date":"2014-11-07T10:03:18","date_gmt":"2014-11-07T09:03:18","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=18298"},"modified":"2014-11-07T10:03:26","modified_gmt":"2014-11-07T09:03:26","slug":"vysetreni-mocoveho-mechyre-uz-neni-tak-neprijemne","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=18298","title":{"rendered":"Vy\u0161et\u0159en\u00ed mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e u\u017e nen\u00ed tak nep\u0159\u00edjemn\u00e9"},"content":{"rendered":"

V\u00a0\u010cR \u017eije p\u0159es 21 tis\u00edc lid\u00ed s\u00a0diagn\u00f3zou n\u00e1doru mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e. Za posledn\u00edch 30 let se v\u00fdskyt t\u00e9to choroby t\u00e9m\u011b\u0159 ztrojn\u00e1sobil. Av\u0161ak nijak dramaticky nevzrostl po\u010det pacient\u016f, kte\u0159\u00ed na n\u00e1dor mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e zem\u0159eli.\u00a0 <\/i><\/span><\/span><\/strong><\/p>\n

ilustra\u010dn\u00ed foto: Flickr.com<\/p>\n

Vysv\u011btlit to m\u016f\u017eeme zkvalitn\u011bn\u00edm diagnostick\u00fdch metod a n\u00e1sledn\u00e9 p\u00e9\u010de po stanoven\u00ed diagn\u00f3zy.<\/b><\/i><\/span><\/span><\/p>\n

Podm\u00ednkou \u00fasp\u011b\u0161n\u00e9 l\u00e9\u010dby je v\u010dasn\u00e1 diagnostika n\u00e1doru <\/b><\/span><\/span><\/span><\/p>\n

Z\u00e1kladn\u00ed metodou pou\u017e\u00edvanou k\u00a0rozpozn\u00e1n\u00ed n\u00e1dor\u016f v m\u011bch\u00fd\u0159i je endoskopick\u00e9 vy\u0161et\u0159en\u00ed, takzvan\u00e1 <\/span><\/span>cystoskopie<\/b><\/span><\/span>. P\u0159i tomto vy\u0161et\u0159en\u00ed se zav\u00e1d\u00ed endoskop mo\u010dovou trubic\u00ed do m\u011bch\u00fd\u0159e, kter\u00fd si n\u00e1sledn\u011b mohou urologov\u00e9 prohl\u00e9dnout a ur\u010dit o jak\u00fd typ n\u00e1doru se u dan\u00e9ho pacienta jedn\u00e1. <\/span><\/span><\/p>\n

\u201e<\/b><\/span><\/span>Toto vy\u0161et\u0159en\u00ed je nep\u0159\u00edjemn\u00e9 hlavn\u011b u mu\u017e\u016f, proto je dnes prov\u00e1d\u00edme tzv. \u201eohebn\u00fdm\u201c p\u0159\u00edstrojem. Nen\u00ed tedy o\u00a0nic nep\u0159\u00edjemn\u011bj\u0161\u00ed ne\u017e nap\u0159\u00edklad zaveden\u00ed c\u00e9vky, tak\u017ee ani mu\u017ei se jej nemus\u00ed nijak ob\u00e1vat, a\u00a0je b\u011b\u017en\u011b prov\u00e1d\u011bno bez nutnosti hospitalizace,\u201c<\/b><\/i><\/span><\/span> vysv\u011btluje prof. MUDr. Marek Babjuk, CSc., p\u0159edseda \u010cesk\u00e9 urologick\u00e9 spole\u010dnosti. <\/span><\/span><\/p>\n

Mezi dal\u0161\u00ed mo\u017en\u00e1 vy\u0161et\u0159en\u00ed, kter\u00fdmi v\u00a0n\u011bkter\u00fdch p\u0159\u00edpadech diagn\u00f3zu up\u0159es\u0148ujeme, pat\u0159\u00ed zobrazovac\u00ed metody, nap\u0159\u00edklad sonografie (ultrazvukov\u00e9 vy\u0161et\u0159en\u00ed mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e a\u00a0ledvin) nebo CT.<\/span><\/span><\/p>\n

Cystoskopii prov\u00e1d\u00edme v situac\u00edch, kdy m\u00e1me podez\u0159en\u00ed na n\u00e1dor m\u011bch\u00fd\u0159e. Nej\u010dast\u011bji tomu b\u00fdv\u00e1 p\u0159i viditeln\u00e9m n\u00e1lezu krve v mo\u010di. Zn\u00e1mkou m\u016f\u017ee b\u00fdt i mikroskopick\u00e1 p\u0159\u00edtomnost krve v mo\u010di, kterou l\u00e9ka\u0159i zachyt\u00ed p\u0159i vy\u0161et\u0159en\u00ed mo\u010di pomoc\u00ed testa\u010dn\u00edch pap\u00edrk\u016f (by\u0165 p\u0159\u00ed\u010din n\u00e1lezu krve v mo\u010di m\u016f\u017ee b\u00fdt cel\u00e1 \u0159ada, tedy nejen n\u00e1dor v m\u011bch\u00fd\u0159i). Vy\u0161et\u0159en\u00ed testa\u010dn\u00edm pap\u00edrkem, tzv. chemick\u00e9 vy\u0161et\u0159en\u00ed mo\u010di, je sou\u010d\u00e1st\u00ed ka\u017ed\u00e9ho vy\u0161et\u0159en\u00ed u praktick\u00e9ho l\u00e9ka\u0159e v\u010detn\u011b preventivn\u00edch prohl\u00eddek a je hrazeno ze zdravotn\u00edho poji\u0161t\u011bn\u00ed.<\/span><\/span><\/p>\n

N\u00e1dory mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e jsou prakticky v\u017edy rakovinn\u00e9ho charakteru<\/b><\/span><\/span><\/span><\/p>\n

N\u00e1dory mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e vych\u00e1zej\u00ed ze sliznice, tedy z\u00a0vrstvi\u010dky, kter\u00e1 vyst\u00fdl\u00e1 vnit\u0159ek mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e. Dle hloubky pror\u016fst\u00e1n\u00ed do st\u011bny m\u011bch\u00fd\u0159e rozli\u0161ujeme n\u00e1dory na <\/span><\/span>povrchov\u00e9 <\/b><\/span><\/span>(neinvazivn\u00ed) a\u00a0<\/span><\/span>infiltruj\u00edc\u00ed <\/b><\/span><\/span>(invazivn\u00ed). <\/span><\/span>\u201e<\/b><\/span><\/span>Povrchov\u00e9 jsou \u010dast\u011bj\u0161\u00ed, statisticky tvo\u0159\u00ed asi 70 \u2013 80 <\/b><\/i><\/span><\/span>%<\/b><\/i><\/span><\/span><\/span> n\u00e1dor\u016f m\u011bch\u00fd\u0159e. Ve v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f jsou povrchov\u00e9 n\u00e1dory mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e vyl\u00e9\u010diteln\u00fdm onemocn\u011bn\u00edm. Invazivn\u00ed n\u00e1dory tvo\u0159\u00ed zbyl\u00fdch 20 \u2013 30 <\/b><\/i><\/span><\/span>%<\/b><\/i><\/span><\/span><\/span> a jsou prognosticky hor\u0161\u00ed. Oba typy od sebe odli\u0161ujeme jak v\u00a0progn\u00f3ze, tak i ve zp\u016fsobu l\u00e9\u010dby,\u201c<\/b><\/i><\/span><\/span> <\/i>uv\u00e1d\u00ed prof. Babjuk. <\/span><\/span><\/p>\n

N\u00e1dory mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e se vyskytuj\u00ed asi 4x \u010dast\u011bji u mu\u017e\u016f ne\u017e u \u017een.<\/span><\/span><\/p>\n

V\u00a0roce 2011 onemocn\u011blo v\u00a0\u010cR n\u00e1dorem mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e 2\u00a0151 obyvatel.<\/span><\/span><\/p>\n

V\u00a0t\u00e9m\u017ee roce zem\u0159elo na n\u00e1dor mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e 842 pacient\u016f. <\/span><\/span><\/p>\n

Nej\u010dast\u011bj\u0161\u00edm p\u0159\u00edznakem n\u00e1doru mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e je n\u00e1lez krve v\u00a0mo\u010di.<\/span><\/span><\/p>\n

Urologov\u00e9 maj\u00ed k\u00a0dispozici modern\u00ed zp\u016fsoby l\u00e9\u010dby <\/b><\/span><\/span><\/span><\/p>\n

Z\u00e1kladem l\u00e9\u010dby u povrchov\u00fdch n\u00e1dor\u016f je <\/span><\/span>endoskopick\u00e1 operace<\/b><\/span><\/span>, odborn\u011b ozna\u010dovan\u00e1 jako TUR (transuretr\u00e1ln\u00ed resekce). Tu urologov\u00e9 v\u00a0n\u011bkter\u00fdch p\u0159\u00edpadech dopln\u00ed o tzv. \u201ev\u00fdplachy\u201c mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e, p\u0159i nich\u017e je do mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e c\u00e9vkou pod\u00e1v\u00e1na l\u00e1tka, jej\u00edm\u017e \u00fakolem je sn\u00ed\u017eit riziko opakovan\u00e9ho v\u00fdskytu n\u00e1doru.<\/span><\/span><\/p>\n

U infiltruj\u00edc\u00edch n\u00e1dor\u016f ji\u017e samotn\u00e1 endoskopick\u00e1 operace nesta\u010d\u00ed. Standardn\u00ed je radik\u00e1ln\u00ed operace, odborn\u011b <\/span><\/span>radik\u00e1ln\u00ed cystektomie<\/b><\/span><\/span>, kdy mus\u00ed b\u00fdt odstran\u011bn cel\u00fd mo\u010dov\u00fd m\u011bch\u00fd\u0159, v\u00a0n\u011bkter\u00fdch p\u0159\u00edpadech i\u00a0s\u00a0mo\u010dovou trubic\u00ed a dal\u0161\u00edmi mu\u017esk\u00fdmi (prostata a semenn\u00e9 v\u00e1\u010dky) nebo \u017eensk\u00fdmi (d\u011bloha, vejcovody, vaje\u010dn\u00edky) pohlavn\u00edmi org\u00e1ny. Tento postup je v\u00a0n\u011bkter\u00fdch p\u0159\u00edpadech kombinov\u00e1n s\u00a0pod\u00e1n\u00edm celkov\u00e9 chemoterapie. <\/span><\/span><\/p>\n

\u201eRadik\u00e1ln\u00ed cystektomie je nej\u00fa\u010dinn\u011bj\u0161\u00ed l\u00e9\u010dbou infiltruj\u00edc\u00edch n\u00e1dor\u016f mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e. Ne v\u0161ichni pacienti jsou v\u0161ak kv\u016fli p\u0159\u00edpadn\u00fdm dal\u0161\u00edm nemocem schopni podstoupit tak n\u00e1ro\u010dnou operaci, jako je odstran\u011bn\u00ed m\u011bch\u00fd\u0159e a\u00a0zaji\u0161t\u011bn\u00ed odtoku mo\u010di. P\u0159edev\u0161\u00edm kv\u016fli n\u00e1ro\u010dnosti operace, jej\u00ed\u017e d\u00e9lka se pohybuje mezi 4 a 7 hodinami. Tyto p\u0159\u00edpady l\u00e9\u010d\u00edme oz\u00e1\u0159en\u00edm a\u00a0sou\u010dasn\u00fdm pod\u00e1n\u00edm chemoterapie,\u201c<\/b><\/i><\/span><\/span> <\/i>objas\u0148uje prof. Babjuk.<\/span><\/span><\/p>\n

Po odstran\u011bn\u00ed mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e mus\u00ed urologov\u00e9 zajistit odtok mo\u010di. Tento postup se naz\u00fdv\u00e1 <\/span><\/span>derivace mo\u010di<\/b><\/span><\/span> a v\u00a0sou\u010dasnosti existuj\u00ed 2 nej\u010dast\u011bji pou\u017e\u00edvan\u00e9 zp\u016fsoby: <\/span><\/span><\/p>\n