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Nip L, Salmo E, Surange R, Calleary J. Mixed histology bladder cancer as a complication of clam ileocystoplasty. BMJ Case Rep 2021; 14:14/1/e238818. [PMID: 33509879 PMCID: PMC7845682 DOI: 10.1136/bcr-2020-238818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A 58-year-old woman with a previous clam ileocystoplasty was referred to the urology department for the investigation of haematuria. CT urogram showed a large left-sided soft tissue mass arising from the bladder. Histological analysis of the shavings from transurethral resection revealed a G3pT2 transitional cell carcinoma and T4N1Mx adenocarcinoma. The patient was referred to oncology for the discussion of palliative chemotherapy; however, in the interim she deteriorated and was admitted to hospital with a post-renal acute kidney injury. A right-sided nephrostomy was inserted relieving her obstruction and she subsequently made a good recovery. This case report illustrates the difficulties in the long-term follow-up of patients having undergone what is now a rarely performed procedure. In the absence of regular cystoscopic follow-up post ileocystoplasty, malignancy may present late and with complications from advanced disease.
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Affiliation(s)
- Lawrence Nip
- Department of Urology, Northern Care Alliance NHS Group, Manchester, UK
| | - Emil Salmo
- Department of Histopathology, Northern Care Alliance NHS Group, Oldham, UK
| | - Raveendra Surange
- Department of Urology, Northern Care Alliance NHS Group, Manchester, UK
| | - John Calleary
- Department of Urology, Northern Care Alliance NHS Group, Manchester, UK
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2
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Miranda EGD, Bizerra MRDS, Waisberg DR, Carnevale J, Silva JF, Waisberg J. Early morphological and histochemical alterations in rats subjected to ileocystoplasty. Acta Cir Bras 2009; 24:393-9. [PMID: 19851693 DOI: 10.1590/s0102-86502009000500010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 06/10/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To study morphologic and histochemical alterations arising at the ileocystoplasty site. METHODS: Sixteen Wistar female rats were subjected to ileocystoplasty and sacrificed after eight weeks. Material collected was divided into four groups for histological and histochemical studies: Group I (control) - isolated ileum segment removed during ileocystoplasty; Group II - ileoileal anastomosis; Group III - ileovesical anastomosis and Group IV - ileal segment from the neobladder. Histological and histochemical study assessed dysplasia, metaplasia, acute and chronic inflammation, fibrosis, atrophy, hypertrophy, total mucins, sialomucins and sulfomucins. The non-parametric Wilcoxon and Mann-Whitney tests were employed in statistical analysis. RESULTS: None of the groups presented dysplasia. Acute inflammation and atrophy occurred in Groups II, III and IV, not reaching statistical significance. Metaplasia was significant only in Group III (p=0.012). Chronic inflammation, fibrosis and hypertrophy were significant in Groups II, III and IV. There was a significant increase in total mucin content in Group IV (p=0.014) and a reduction in Group III (p=0.016). Increases in sialomucins were observed in samples for Groups III (p=0.003) and IV (p=0.002) along with reduced sulfomucins in samples from Groups III (p=0.013) and IV (p=0.008). CONCLUSION: Ileocystoplasty in female rats caused squamous metaplasia, chronic inflammatory infiltration, fibrosis, hypertrophy, increase in sialomucin content, reduction in sulfomucins, and alterations in total mucin content with statistical significance, as well acute inflammatory infiltration and muscular atrophy with less intensity.
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Miyano G, Yamataka A, Okada Y, Shimotakahara A, Kaneko K, Lane GJ, Yamashiro Y, Miyano T. Sigmoidocolocystoplasty for augmentation of iatrogenic small capacity bladder caused by direct injury to the bladder during inguinal hernia repair: long-term follow-up. Pediatr Surg Int 2004; 20:61-4. [PMID: 14758496 DOI: 10.1007/s00383-003-1084-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inguinal hernia repair is the most common operation performed in pediatric surgical practice. However, this procedure can be difficult, even in the most experienced hands, and result in complications, especially in small infants. Injury to the bladder is one of the known complications of inguinal herniotomy, especially in infants less than 6 months old. We report the long-term follow-up of a case having bladder injury during inguinal hernia repair at the age of 3 months and at the age of 10 underwent sigmoidocolocystoplasty for augmentation of a small, contracted bladder and high-grade vesicoureteric reflux caused by the bladder injury.
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Affiliation(s)
- Go Miyano
- Departments of Pediatric Surgery and Pediatrics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Qiu H, Kordunskaya S, Yantiss RK. Transitional cell carcinoma arising in the gastric remnant following gastrocystoplasty: a case report and review of the literature. Int J Surg Pathol 2003; 11:143-7. [PMID: 12754637 DOI: 10.1177/106689690301100216] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Urinary bladder augmentation with segments of the stomach (gastrocystoplasty), small bowel, or large intestine (enterocystoplasty) improves capacity and compliance in patients with bladder dysfunction. Although malignant complications of enterocystoplasty have been reported, the risk of malignancy in the setting of gastrocystoplasty is not known. We describe the case of a 73-year-old woman who developed a transitional cell carcinoma associated with transitional cell metaplasia and dysplasia of the gastric epithelium 14 years following gastrocystoplasty. To our knowledge, this is the first reported case of a malignant complication of this surgical procedure. We conclude that patients who have undergone gastrocystoplasty are at an increased risk for the development of malignancy in the neobladder and require close long-term follow-up, similar to patients who have undergone enterocystoplasty.
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Affiliation(s)
- Honghui Qiu
- Department of Pathology, UMass Memorial Health Care, Worcester, MA 01655, USA
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5
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Abstract
Children who develop end-stage renal disease (ESRD) as a result of obstructive uropathies require evaluation and treatment of associated bladder dysfunction to ensure a good outcome following renal transplantation. Bladder dynamics can often be optimized medically, although surgical intervention is occasionally necessary. For those patients who require bladder augmentation, the use of a dilated native ureter (ureterocystoplasty) is preferred to the more commonly used intestine or stomach (enterocystoplasty), which carry a higher risk of complications. Unfortunately, most patients do not have a suitable anatomy for ureterocystoplasty and, by necessity, intestine or stomach has to be utilized. Herein, we describe the successful application of ureterocystoplasty in the presence of ESRD and a solitary kidney prior to renal transplantation. We believe that owing to the many advantages of native urothelium, every effort should be made to use ureter and avoid the use of intestine.
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Affiliation(s)
- Eric A Kurzrock
- Department of Urology, University of California, Davis Children's Hospital, Sacramento, California 95817, USA
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Miyano T, Yamataka A, Iwashita K, Morioka A, Lane GJ, Kobayashi H, Okazaki T. Histology of the neobladder mucosa after sigmoidocolocystoplasty. J Pediatr Surg 2000; 35:104-8. [PMID: 10646785 DOI: 10.1016/s0022-3468(00)80024-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to examine the histopathology of neobladder mucosa biopsy specimens obtained routinely as part of postsigmoidocolocystoplasty (SCP) follow-up. METHODS One hundred cases of SCP (mean age at surgery, 10.6 years) performed by the authors were examined for the presence of dysplasia or malignant changes in the mucosa of the neobladder using H&E and proliferating cell nuclear antigen (PCNA) staining. RESULTS No dysplastic or malignant changes were identified in any case. Metaplasia was found in 5 cases and hyperplasia in 2. There were no major differences found on H&E and PCNA staining of specimens obtained after different periods of follow-up post-SCP; follow-up was short term (up to 5 years) in 44 cases, medium term (from 5 to 10 years) in 48 cases, and long term (over 10 years) in 8 cases. PCNA staining was significantly more intense in subjects who stopped regular bladder irrigations (BI) post-SCP and in subjects in whom bladder stones developed (P < .05; Welch's t test), compared with subjects who continued BI and subjects in whom bladder stones did not develop. CONCLUSIONS After SCP, patients are advised to continue BI. Regular biopsies should be part of routine follow-up, especially in subjects with bladder stones.
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Affiliation(s)
- T Miyano
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Barron BJ, Imam S, Lamki L, Redwine MD, Nightingale JA, Kahan B. Augmented enterocystoplasty for neurogenic bladder associated with renal transplantation: appearance on Tc-99m MAG3 renal transplant scan. Clin Nucl Med 1998; 23:156-9. [PMID: 9509929 DOI: 10.1097/00003072-199803000-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Enterocystoplasty (bladder augmentation) is a method of increasing bladder capacity in patients with small or neurogenic bladders in order to prevent vesicoureteral reflux. In patients with poorly compliant bladders, enterocystoplasty, which consists of a segment of detubularized small bowel or a portion of the stomach attached to the bladder, often helps to reduce the intravesicular pressures, thus reducing the likelihood of infection. It is also useful in treating bladder dysfunction in children with end-stage renal disease who require renal transplantation. Radiographic evaluation of patients with a renal transplant and augmented bladder often can be confusing, and may suggest a urine leak or hematoma. We report a patient with a renal transplant, bladder augmentation, and rising serum creatinine who underwent renal scintigraphy and ultrasonography.
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Affiliation(s)
- B J Barron
- Department of Radiology, The University of Texas-Houston Medical School, 77030, USA
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8
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Malone MJ, Izes JK, Hurley LJ. Carcinogenesis. The fate of intestinal segments used in urinary reconstruction. Urol Clin North Am 1997; 24:723-8. [PMID: 9391525 DOI: 10.1016/s0094-0143(05)70414-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The actual mechanism for risk of developing cancer in intestinal segments used for urinary diversion remains uncertain. The clinical and laboratory experiences are reviewed in this article. The pathogenesis is multifaceted, involving initiators and promoters of carcinogenesis. Molecular genetic technology may provide the key to decoding the mechanisms involved.
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Affiliation(s)
- M J Malone
- Department of Urology, Lahey Hitchcock Medical Center, Burlington, Massachusetts, USA
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Britanisky RG, Poppas DP, Shichman SN, Mininberg DT, Sosa RE. Laparoscopic laser-assisted bladder autoaugmentation. Urology 1995; 46:31-5. [PMID: 7604477 DOI: 10.1016/s0090-4295(99)80154-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The purpose of this study is to examine the feasibility of performing a laparoscopic bladder autoaugmentation and to assess the urodynamic characteristics of an autoaugmented bladder. METHODS Laparoscopic bladder autoaugmentation was performed in 9 female canines (20 to 30 kg). Following laparoscopic access to the peritoneal cavity, a midline bladder seromyotomy was performed using the potassium titanyl phosphate 532 nm laser. This produced a large bladder diverticulum. Changes in bladder volume and compliance were quantified over a 3-month period of follow-up. RESULTS Urodynamic evaluation demonstrated an increase in bladder capacity 6 weeks postoperatively in 8 of 9 dogs, with an average volume increase of 45%. Bladder compliance improved in 7 of 9 dogs with an average increase in compliance of 67%. Three months postoperatively, bladder capacity remained increased in 5 of 9 dogs, with an average increase in volume of only 5.3%. An improvement in compliance was sustained in 5 of 9 animals with an average increase of 13.9%. Laparoscopic exploration revealed grossly normal bladders with adhesions of omentum to the seromyotomy site in all canines and the anterior abdominal wall in 2 of 9 canines. Histologically, the seromyotomy site was devoid of muscle with an intact urothelium and a proliferation of loose connective tissue. CONCLUSIONS The technique of laparoscopic bladder autoaugmentation can be performed easily in the canine model. Although results at 6 weeks show significant improvement, the longer term, 3-month results were not statistically significant. This technique has the potential to offer a minimally invasive correction for patients with low-capacity, high-pressure bladders that have failed pharmacologic treatment.
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Affiliation(s)
- R G Britanisky
- James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center, NY 10021, USA
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Buson H, Diaz DC, Manivel JC, Jessurun J, Dayanc M, Gonzalez R. The development of tumors in experimental gastroenterocystoplasty. J Urol 1993; 150:730-3. [PMID: 8326635 DOI: 10.1016/s0022-5347(17)35599-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Bladder augmentation with segments of the gastrointestinal tract is commonly used to treat patients with small or noncompliant bladders. Reliable data on the incidence of tumors in patients with enterocystoplasty are not available. In the small number of cases reported in the literature the mean latency period is approximately 18 years. We designed a study in Sprague Dawley rats to try to determine the risk of carcinogenesis in different types of augmentation cystoplasty and its possible relationship with infected urine, and to investigate the possibility of detecting the tumors by cytological analysis. We performed 30 gastrocystoplasties, 35 sigmoid cystoplasties, 30 ileocystoplasties and 10 sham operations, and used 10 nonoperated animals as controls. The animals were sacrificed upon completing 1 year of followup and bladder urine samples were collected at the time of sacrifice. Of 115 animals 86 were available for histological evaluation (26 gastrocystoplasty, 22 sigmoid cystoplasty, 18 ileocystoplasty, and all sham and control animals). Mean followup was 11.2 months in the gastrocystoplasty, 11.8 months in the sigmoid cystoplasty, and 12 months in the ileocystoplasty, sham and control groups. Multifocal or superficial transitional metaplasia was found in 65.4% of the gastrocystoplasty, 50% of the sigmoid cystoplasty and 55.5% of the ileocystoplasty animals. Proliferations that we classified as papillary hyperplasia were present in 53.8% of the gastrocystoplasty, 40.9% of the sigmoid cystoplasty and none of the ileocystoplasty rats. The proliferations occurred either at or close to the anastomosis between the bladder and the gastric or colonic patch, or in areas of transitional metaplasia. Cytological urinalysis was negative for neoplastic cells in all cases. No correlation was found between the occurrence of papillary hyperplasia and urinary infection. These data indicate that in rats transitional metaplasia is common in gastrocystoplasty, sigmoid cystoplasty and ileocystoplasty, and that papillary hyperplasia may occur near or at the anastomosis, or in areas of transitional metaplasia in either gastrocytoplasty or sigmoid cystoplasty. In contrast to other studies, we observed no examples of papillary hyperplasia in the ileocystoplasty group in this series. No transitional cell carcinomas or adenocarcinomas were identified in this study. It is not known if these papillary lesions have an increased malignant potential, thus further studies with longer followup are warranted.
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Affiliation(s)
- H Buson
- Department of Urologic Surgery, University of Minnesota Hospital and Clinics, Minneapolis
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Abstract
The possibility of recurrent colonic metaplasia occurring as a complication of pelvic ileal pouches after ileo-rectal anastomosis has been raised. Several reports have documented malignant bladder tumours developing in patients many years after an ileocystoplasty. The case of a 50 year old man, who developed a tubulovillous adenoma in the ileal patch 30 years after an ileocystoplasty had been performed to enlarge a tuberculous shrunken bladder, is reported. The adjacent small intestinal mucosa showed features suggestive of colonic metaplasia.
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Affiliation(s)
- P H King
- Department of Histopathology, Leicester General Hospital
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12
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Gepi-Attee S, Ganabathi K, Abrams PH, MacIver AG. Villous adenoma in augmentation colocystoplasty: a case report and discussion of the pathogenesis. J Urol 1992; 147:128-30. [PMID: 1729503 DOI: 10.1016/s0022-5347(17)37157-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Reports of malignant tumors in enterocystoplasties have recently been accumulating. To date no case of benign tumors has been recorded. We present a case of villous adenoma in a sigmoid colocystoplasty. The possible etiological factors and pathogenesis are discussed, and recommendations are made about followup.
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Affiliation(s)
- S Gepi-Attee
- Department of Urology, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
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13
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Spencer JR, Filmer RB. Malignancy associated with urinary tract reconstruction using enteric segments. Cancer Treat Res 1992; 59:75-87. [PMID: 1347696 DOI: 10.1007/978-1-4615-3502-7_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
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Motley RC, Montgomery BT, Zollman PE, Holley KE, Kramer SA. Augmentation cystoplasty utilizing de-epithelialized sigmoid colon: a preliminary study. J Urol 1990; 143:1257-60. [PMID: 2342198 DOI: 10.1016/s0022-5347(17)40249-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The use of bowel segments for bladder replacement or augmentation has been associated with metabolic complications and obstruction due to mucus production. Establishment of a transitional epithelium over the de-epithelialized surface of a segment of intestine might alleviate these complications. Twenty Holstein bull calves underwent sigmoidocystoplasty. Fourteen experimental animals had the epithelium of the sigmoid removed before augmentation. Six calves with intact mucosa served as controls. Fifteen calves survived the study: 11 experimentals and four controls. Cystectomies were performed at four, six, eight, or 12 weeks. Ninety-one percent (10/11) of the experimental calves had almost complete epithelialization of the de-epithelialized graft. All experimental animals had residual colonic mucosa or mucoceles. Nine of 11 experimental calves (82%) had greater than 25% contracture of the sigmoid graft. Two animals had less than 25% graft contracture (1) or formed a wide-mouthed true diverticulum (1) in the grafted segment. All control animals formed a wide-mouthed true diverticulum and had no graft contracture.
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Affiliation(s)
- R C Motley
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905
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Affiliation(s)
- R B Filmer
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit
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Affiliation(s)
- J Golomb
- Department of Surgery, UCLA School of Medicine
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Golomb J, Klutke CG, Lewin KJ, Goodwin WE, deKernion JB, Raz S. Bladder neoplasms associated with augmentation cystoplasty: report of 2 cases and literature review. J Urol 1989; 142:377-80. [PMID: 2545929 DOI: 10.1016/s0022-5347(17)38767-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Bladder neoplasms associated with augmentation cystoplasty have been reported to date in 12 patients. We add 2 cases: 1 with invasive transitional cell carcinoma involving the native bladder and bowel segment, and 1 with a poorly differentiated invasive oat cell (small cell) carcinoma confined to the bladder. The predisposing factors and pertinent literature are reviewed.
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Affiliation(s)
- J Golomb
- Department of Surgery, UCLA School of Medicine
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Kim KS, Susskind MR, King LR. Ileocecal ureterosigmoidostomy: an alternative to conventional ureterosigmoidostomy. J Urol 1988; 140:1494-8. [PMID: 3193521 DOI: 10.1016/s0022-5347(17)42083-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We describe a 1-stage procedure that involves use of the ileocecal segment as an intervening urine conduit to the large bowel to achieve a continent diversion. The ureters are anastomosed end to end to the terminal ileum that is intussuscepted into the cecum. The cecum then is joined to the lower sigmoid by an end-to-side anastomosis. Mixed urine and feces are eliminated through the rectum. The results in 5 patients with exstrophy and 1 with epispadias between 5 months and 13 years old are reported. Ureteral reflux was not observed. Urinary tract infection developed in 2 patients. Ileocecal ureterosigmoidostomy is a reasonable alternative to intact ureterosigmoidostomy that may reduce the risk of development of cancer.
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Affiliation(s)
- K S Kim
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
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Myrén CJ, Beuke HP, Thybo E. Functional results after ileocystoplasty. Int Urol Nephrol 1988; 20:269-74. [PMID: 3403196 DOI: 10.1007/bf02549515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The functional results after ileocystoplasty were studied in seven patients with interstitial cystitis, irradiated bladder and neurogenic bladder dysfunction. None of the patients had had symptomatic improvement by medical or surgical means. All patients were suffering from urinary frequency and five patients had severe urge incontinence or suprapubic pains. Postoperatively the patients were followed from 8 to 66 months and evaluated by urodynamic examinations and interviews. Urinary frequency was improved in all patients but one with interstitial cystitis who had persisting suprapubic pains. None had residual urine volume greater than 30 ml postoperatively. It is concluded that bladder augmentation by ileocystoplasty is an excellent method of treatment for patients with contracted bladder secondary to interstitial cystitis, irradiated bladder, and detrusor hyperreflexia and sphincter dyssynergia.
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Affiliation(s)
- C J Myrén
- Department of Urology, Odense University Hospital, Denmark
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Hasegawa S, Ohshima S, Kinukawa T, Matsuura O, Takeuchi Y, Hattori R, Murakami S. Adenocarcinoma of the bladder 29 years after ileocystoplasty. BRITISH JOURNAL OF UROLOGY 1988; 61:162. [PMID: 3349282 DOI: 10.1111/j.1464-410x.1988.tb05068.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- S Hasegawa
- Department of Urology, Shakai Hoken Chukyo Hospital, Nagoya, Japan
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Abstract
A case is presented of squamous cell carcinoma of the cervix with an isolated metastasis to an ileal loop six years after diversion and seven years after definitive treatment of the primary lesion with irradiation.
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