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Tumour formation within intestinal segments transposed to the urinary tract

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Abstract

Patients and their urologists are quite rightly concerned about the possibility of neoplastic change within intestinal segments transposed to the lower urinary tract. This fear arises from the occurrence of latent adenocarcinoma arising from the urocolic anastomosis in approximately 10% of patients who underwent ureterosigmoidostomy in childhood. The present text provides an update of previous reviews and details work published since 1990 on epidemiological, experimental and clinical studies. Consideration of the collected evidence confirms the increased risk of colonic neoplasia following mixing of the faecal and urinary stream by ureterosigmoidostomy or its more recent variants. In contrast, the occurrence of tumours within transposed intestinal segments appears more likely to be related to the underlying urinary tract disease for which the surgery was performed rather than exposure of the intestinal mucosa to urine. This conclusion is, however, based on low level evidence and, despite the reassuring findings, caution is advised until more robust data are available to provide a confident risk assessment.

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References

  1. Ali El Dein B, El Tabey N, Abdel Latif M, Abdel Rahim M, El Bahnasawy MS (2002) Late uroileal cancer after incorporation of ileum into the urinary tract. J Urol 167:84–88

    Google Scholar 

  2. Anonymous. Hospital episode statistics (HES). Electronic publication in public domain at http://www.doh.gov.uk. Accessed 20th April 2004

  3. Aragona F, De Caro R, Parenti A, Artibani W, Bassi P, Munari PF, Pagano F (1998) Structural and ultrastructural changes in ileal neobladder mucosa: a 7-year follow-up. Brit J Urol 81:55–61

    Article  CAS  PubMed  Google Scholar 

  4. Azimuddin K, Khubchandani IT, Stasik JJ, Rosen L, Riether RD (1999) Neoplasia after ureterosigmoidostomy. Dis Colon Rectum 42:1632–1638

    CAS  PubMed  Google Scholar 

  5. Badawi AF (1996) Molecular and genetic events in schistosomiasis-associated human bladder cancer: role of oncogenes and tumor suppressor genes. Cancer Lett 105:123–138

    Article  CAS  PubMed  Google Scholar 

  6. Barrington JW, Fulford S, Griffiths D, Stephenson TP (1997) Tumors in bladder remnant after augmentation enterocystoplasty. J Urol 157:482–485

    Google Scholar 

  7. Bono Arino A, Sanz Velez JI, Esclarin Duny MA, Berne Manero JM, Vera Alvarez J (2001) Signet ring-cell adenocarcinoma in colocystoplasty ( in Spanish). Act Urol Espanol 25:312–314

    Google Scholar 

  8. Buson H, Diaz DC, Manivel JC, Jessurun J, Dayanc M, Gonzalez R (1993) The development of tumors in experimental gastroenterocystoplasty. J Urol 150:730–733

    Google Scholar 

  9. Carter A, Gillatt DA (1996) Recurrent transitional cell carcinoma arising with-in an ileal conduit following cystectomy. A case report and review of the literature. Eur Urol 30:519–520

    CAS  PubMed  Google Scholar 

  10. Crissey MM, Steele GD, Gittes RF (1980) Rat model for carcinogenesis in ureterosigmoidostomy. Science 207:1079–1080

    CAS  PubMed  Google Scholar 

  11. Deane AM, Woodhouse CR, Parkinson MC (1984) Histological changes in ileal conduits. J Urol 132:1108–1111

    Google Scholar 

  12. De Riese W, Warmbold H (1986) Adenocarcinoma in exstrophy of the bladder. A case report and review of the literature. Int Urol Nephrol 18:159–162

    PubMed  Google Scholar 

  13. DeWolf WC (1997) Tumors in bladder remnant after augmentation enterocystoplasty: editorial comment. J Urol 157:485–486

    Google Scholar 

  14. Djavan B, Litwiller SE, Milchgrub S, Roehrborn CG (1995) Mucinous adenocarcinoma in defunctionalized bladders. Urology 46:107–110

    Google Scholar 

  15. Docimo SG, Chow NH, Steiner G, Silver RI, Rodriguez R, Kinsman S, Sidransky D, Schoenberg M (1999) Detection of adenocarcinoma by urinary micro-satellite analysis after augmentation cystoplasty. Urology 54:561–563

    Google Scholar 

  16. Fichtner J (1999) Follow-up after urinary diversion. Urol Int 63:40–45

    Article  CAS  PubMed  Google Scholar 

  17. Filmer RB, Spencer JR (1990) Malignancies in bladder augmentations and intestinal conduits. J Urol 143:671–678

    Google Scholar 

  18. Garvin DD, Weber CH, Polsky MS (1977) Carcinoma in the defunctionalized bladder: report of a case and review of the literature. J Urol 117:669–670

    Google Scholar 

  19. Gatti R, Ferretti S, Bucci G, Simonazzi M, Cortellini P, Orlandini G (1999) Histological adaptation of orthotopic ileal neobladder mucosa: 4-year follow-up of 30 patients. Eur Urol 36:588–594

    Google Scholar 

  20. Gerharz EW, Turner WH, Kälble T, Woodhouse CRJ (2003) Metabolic and functional consequences of urinary reconstruction with bowel. BJU Int 91:143–149

    Article  CAS  PubMed  Google Scholar 

  21. Gitlin JS, Wu XR, Sun TT, Ritchey ML, Shapiro E (1999) New concepts of histological changes in experimental augmentation cystoplasty: insights into the development of neoplastic transformation at the enterovesical and gastro-vesical anastomosis. J Urol 162:1096–1100

    Google Scholar 

  22. Gittes RF (1986) Carcinogenesis in ureterosigmoidostomy. Urol Clin N Am 13:201–205.

    Google Scholar 

  23. Greenwell TJ, Venn SN, Mundy AR (2001) Augmentation cystoplasty. BJU Int 88:511–525

    Article  CAS  PubMed  Google Scholar 

  24. Gröschel J, Riedasch G, Kälble T, Tricker AR (1992) Nitrosamine excretion in patients with continent ileal reservoirs for urinary diversion. J Urol 147:1013–1016

    Google Scholar 

  25. Harper M, Fowler CJ, Dasgupta P (2004) Botulinum toxin and its applications in the lower urinary tract. BJU Int 93:702–706

    Article  CAS  PubMed  Google Scholar 

  26. Hautmann RE (2003) Urinary diversion: ileal conduit to neobladder. J Urol 169:834–842

    Google Scholar 

  27. Hohenfellner R (1992) Ureterosigmoidostomy: past, present and future. Scand J Urol Nephrol [Suppl] 142:86–89

    Google Scholar 

  28. Husmann DA, Spence HM (1990) Current status of tumor of the bowel following ureterosigmoidostomy: a review. J Urol 144:607–610

    Google Scholar 

  29. Kälble T, Tricker AR, Friedl P, Waldherr R, Hoang J, Staehler G, Möhring K (1990) Ureterosigmoidostomy: long-term results, risk of carcinoma and etiological factors for carcinogenesis. J Urol 144:1110–1114

    Google Scholar 

  30. Kälble T, Tricker AR, Berger M, Amelung F, Waldherr R, Hothorn L, Möhring K, Staehler G (1991) Tumor induction in a rat model for ureterosigmoidostomy without evidence of nitrosamine formation. J Urol 146:862−866

    Google Scholar 

  31. Kälble T, Tricker AR, Hoang J, Möhring K, Schmidt GH, Staehler G (1991) Effect of vitamin C on endogenous formation of N-nitrosamines in ureterosigmoidostomy patients. Urol Int 46:22–26

    PubMed  Google Scholar 

  32. Kälble T, Busse K, Amelung F, Waldherr R, Berger MR, Edler L, Riedmiller H (1995) Tumor induction and prophylaxis following different forms of intestinal urinary diversion in a rat model. Urol Res 23:365–370

    Google Scholar 

  33. Kälble T, Austen M (2002) Sekundäre Malignome nach Harnableitungen unter Verwendung von Darm. Akt Urol 33:120–123

    Article  Google Scholar 

  34. Kamyshan IS, Klimenko IA, Kirichenko SA (2000) Urinary bladder cancer in patients with tuberculous and post-tuberculous cystitis (in Russian). Urologiia 2:21–24

    Google Scholar 

  35. L’Esperance JO, Lakshmanan Y, Trainer AF, Jiang Z, Blute RD, Ayvazian PA (2001) Adenocarcinoma in an Indiana pouch after cystectomy for transitional cell carcinoma. J Urol 165:901–902

    Google Scholar 

  36. Lina BA, Van Garderen-Hoetmer A (1999) Effect of urinary pH on the pro-gression of urinary bladder tumours. Food Chem Toxicol 37:1159–1166

    Article  CAS  PubMed  Google Scholar 

  37. Link RE, Lerner SP (2001) Rebuilding the lower urinary tract after cystectomy: a roadmap for patient selection and counseling. Semin Urol Oncol 19:24–36

    Google Scholar 

  38. Lisle D, Cataldo P, Bibawi SE, Wood M (2000) Colonic adenocarcinoma occur-ring in an Indiana pouch: report of a case and review of the literature. Dis Colon Rectum 43:864–867

    CAS  PubMed  Google Scholar 

  39. Little JS, Klee LW, Hoover DM, Rink RC (1994) Long-term histopathological changes observed in rats subjected to augmentation cystoplasty. J Urol 152:720–724

    Google Scholar 

  40. Malone MJ, Izes JK, Hurley LJ (1997) Carcinogenesis. The fate of intestinal segments used in urinary reconstruction. Urol Clin N Am 24:723–728

    Google Scholar 

  41. Miyake H, Eto H, Takechi Y, Kamidono S, Hara I (2003) Increased urinary 8-hydroxy-2′-deoxyguanosine excretion after ileal neobladder replacement. BJU Int 91:657–660

    CAS  PubMed  Google Scholar 

  42. Miyoshi Y, Asakura T, Matsuzaki J, Fukuda M, Satomi Y, Akabane H (1996) A case of CEA and CA19–9 producing recurrent transitional cell carcinoma in an Indiana pouch after total cystectomy (in Japanese). Hinyokika Kiyo—Act Urol Jpn 42:961–964

    Google Scholar 

  43. Mostafa MH, Sheweita SA, O’Connor PJ (1999) Relationship between schistosomiasis and bladder cancer. Clin Microbiol Rev 12:97–111

    Google Scholar 

  44. Mühlberger F (1991) Bladder carcinoma following bladder tuberculosis (in German). Schweiz Rund Med Praxis 80:1046–1047

    Google Scholar 

  45. Murray K, Nurse DE, Mundy AR (1995) Malignant change in enterocystoplasty: a histochemical assessment. Urol Res 23:21–25

    Google Scholar 

  46. N’Dow J, Leung HY, Marshall C, Neal DE (1998) Bowel dysfunction after bladder reconstruction. J Urol 159:1470–1475

    Google Scholar 

  47. Parenti A, Aragona F, Bortuzzo G, De Caro R, Pagano F (1999) Abnormal pat-terns of mucin secretion in ileal neobladder mucosa: evidence of preneoplastic lesion? Eur Uro 35:98–101

    Article  CAS  Google Scholar 

  48. Poulsen AL, Steven K (1996) Acid-base metabolism after bladder substitution with the ileal urethral Kock reservoir. Brit J Urol 78:47–53

    Article  CAS  PubMed  Google Scholar 

  49. Qiu H, Kordunskaya S, Yantiss RK (2003) Transitional cell carcinoma arising in the gastric remnant following gastrocystoplasty: a case report and review of the literature. Int J Surg Pathol 11:143–147

    Google Scholar 

  50. Sanchez Zalabardo D, Lopez Ferrandis J, Arocena Garcia-Tapia J, Sanz Perez G, Zudaire Bergera J, Berian Polo JM (2001) Recurrent urothelial tumor in orthotopic neobladder (in Spanish). Act Urol Espanol 25:600–602

    Google Scholar 

  51. Senkul T, Yildirim S, Iseri C, Karademir K, Erden D, Baykal K (2003) Histo-pathologic changes in the mucosa of ileal orthotopic neobladder: findings in 24 patients followed up for 5 years. Scand J Urol Nephrol 37:202–204

    Article  PubMed  Google Scholar 

  52. Shaaban AA, Sheir KZ, El Baz MA (1992) Adenocarcinoma in an isolated rectosigmoid bladder: case report. J Urol 147:457–458

    Google Scholar 

  53. Shands C, McDougal WS, Wright EP (1989) Prevention of cancer at the urothelial enteric anastomotic site. J Urol 141:178 –181

    Google Scholar 

  54. Shimamoto C, Hirata I, Takao Y, Takiuchi H, Morikawa H, Nakagawa Y, Katsu K (2000) Alteration of colonic mucin after ureterosigmoidostomy. Dis Colon Rectum 43:526–531

    CAS  PubMed  Google Scholar 

  55. Shokeir AA, Shamaa M, El Mekresh MM, El Baz M, Ghoneim MA (1995) Late malignancy in bowel segments exposed to urine without fecal stream. Urology 46:657–661

    Google Scholar 

  56. Spencer JR, Steckel J, May M, Marion D, Hernandez K, Vaughan ED (1993) Histopathological and bacteriological findings in long-term ileocystoplasty and colocystoplasty in the rat. J Urol 150:1321–1325

    Google Scholar 

  57. Takayama K, Kumazawa J, Minoda K (1986) Bladder tumor occurring in the contracted bladder following urinary tract tuberculosis. Eur Urol 12:448–450

    CAS  PubMed  Google Scholar 

  58. Tsuboniwa N, Miki T, Kuroda M, Maeda O, Saiki S, Kinouchi T, Usami M, Kotake T (1996) Primary adenocarcinoma in an ileal conduit. Int J Urol 3:64–66

    CAS  PubMed  Google Scholar 

  59. Tumino R, Serrao A, Ninfo V (2003) Leiomyosarcoma at the site of an ileal neobladder: a heretofore unreported occurrence. Int J Surg Pathol 11:149–151

    Google Scholar 

  60. Vajda P, Kaiser L, Magyarlaki T, Farkas A, Vastyan AM, Pinter AB (2002) Histological findings after colocystoplasty and gastrocystoplasty. J Urol 168:698–701

    Google Scholar 

  61. Vesth N, Kay L, Nordkild P (1985) Adenocarcinoma in the defunctionalized bladder. Scand J Urol Nephrol 19:303–304

    Google Scholar 

  62. Woodhams SD, Greenwell TJ, Smalley T, Mundy AR (2001) Factors causing variation in urinary N-nitrosamine levels in enterocystoplasties. BJU Int 88:187–191

    Article  CAS  PubMed  Google Scholar 

  63. Woodhouse CR (1992) Late malignancy risk in urology. Brit J Urol 70:345–351

    CAS  PubMed  Google Scholar 

  64. Wu B, Watanabe H, Nakagawa S, Sugimoto K (1995) Effect of BBN on the small intestine transplanted to the urinary bladder of rat (in Japanese). Hinyo-kika Kiyo—Act Urol Jpn 41:665–668

    Google Scholar 

  65. Yip SK, Wong MP, Cheung MC, Li JH (1999) Mucinous adenocarcinoma of renal pelvis and villous adenoma of bladder after a caecal augmentation of bladder. Aust N Z J Surg 69:247–248

    Article  CAS  PubMed  Google Scholar 

  66. Yokoyama M, Fujii Y, Okuno T, Kawakami S, Kobayashi T, Masuda H, Kageyama Y, Kihara K (2003) Adenocarcinoma arising at the ileoileal anastomotic site of Scheele’s ring. Int J Urol 10:495–497

    Google Scholar 

  67. Yong SM, Dublin N, Pickard R, Cody DJ, Neal DE, N’Dow J (2004) Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy (Cochrane Review). In: The Cochrane Library, issue 2. John Wiley, Chichester

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  1. School of Surgical and Reproductive Sciences, The Medical School, 3rd Floor, Leech Building, University of Newcastle upon Tyne, Framlington Place, NE2 4HH, Newcastle upon TyneUK

    Robert Pickard

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Pickard, R. Tumour formation within intestinal segments transposed to the urinary tract. World J Urol 22, 227–234 (2004). https://doi.org/10.1007/s00345-004-0438-4

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