Gastric cancer in augmentation gastrocystoplasty

A 27-year-old man operated for myelomeningocele in the neonatal period and for augmentation gastrocystoplasty at age 13 years for voiding dysfunction, was diagnosed with gastric adenocarcinoma on the stomach side of bladder augmentation. A radical cystectomy and an ileal conduit procedure were performed and the pathologist confirmed a poorly differentiated gastric adenocarcinoma. Urologists should be aware of this potential degeneration, and long-term follow-up is mandatory to detect malignization of these cystoplasties.     

Hypergastrinemia following antral gastrocystoplasty

Antral gastrocystoplasty has been previously described as an effective method of bladder augmentation or replacement. Six dogs underwent gastrocystoplasty. Two bladders were augmented utilizing the gastric fundus, one antral augmentation was performed, and three total bladder replacements were created utilizing the antrum. Each dog was followed for at least twelve months or until death from peptic ulcer disease with periodic evaluation for urinary continence, serum gastrin level, serum electrolytes, urine culture, urine pH and the radiographic appearance of the urinary reservoir and upper tracts. All four dogs with antral gastrocystoplasties developed severe hypergastrinemia and two demonstrated gross ulcers. In contrast, the two dogs with fundic augmentation did not show elevation of serum gastrin levels or evidence of peptic ulcer disease. Severe hypergastrinemia can be expected following antral gastrocystoplasty and the resultant ulcer disease can be fatal.     

Hypergastrinemia following gastrocystoplasty in rats

Gastrocystoplasty has been previously described as an effective method of bladder augmentation or replacement. Twenty-four female Wistar rats were divided into three groups of eight animals each: control (G1), partial gastrectomy with the gastric body (G2) and gastrocystoplasty with the gastric body (G3). The period of observation was 2 months and the parameter assessed was serum gastrin. Increases in serum gastrin were seen in 62.5% (5/8) of rats in group 2 and in 50% (4/8) of rats in group 3. Our results suggest that, in rats, hypergastrinemia is induced by the partial surgical removal of the gastric body and is not due to gastrocystoplasty.     

Hand-assisted laparoscopic autoaugmentation gastrocystoplasty

Background: Autoaugmentation gastrocystoplasty has been previously performed successfully. This set of experiments was conducted to determine the feasibility of performing autoaugmentation gastrocystoplasty laparoscopically. Methods: Hand-assisted laparoscopic autoaugmentation gastrocystoplasty was performed on 15 mongrel dogs. The surgery was carried out with two 10-mm trocars and a 6-cm Pfannenstiel incision. The gastric wedge, supplied by the right gastroepiploic artery, was resected with two applications of an endoscopic gastrointestinal anastomosis (GIA) stapler. The pedicle was demucosalized, and the anastomosis to the bladder was completed through the Pfannenstiel incision. Results: All of the dogs were successfully treated laparoscopically and were eating at 48 h. There was no evidence of anastomotic leak dehiscence at the gastric resection staple line. Conclusion: Hand-assisted laparoscopic autoaugmentation gastrocystoplasty can be performed successfully in dogs. This operation may offer a superior alternative to standard bladder autoaugmentation procedures in children suffering from congenital bladder disorders.     

胃代膀胱术后生理及临床的初步研究

目的探讨胃代膀胱术后的生理机能及临床效果。方法对１４例胃代膀胱患者进行术后随访,检测血清胃泌素、电解质、尿液ｐＨ值等,并与尿动力学、影像学结果进行综合分析。结果随访６～７３个月,术后血清胃泌素、电解质、尿液ｐＨ值均在正常范围,贮尿囊排尿期压力２１．４～３８．８ｃｍＨ２Ｏ,小于正常值;胃代膀胱造影未见输尿管返流,双肾无积水,代膀胱粘膜活检为慢性炎症,免疫组化检查Ｇ细胞较正常减少。结论胃代膀胱术后并发症少,相关生理指标接近正常,在临床上值得推广。     

Histologic findings after gastrocystoplasty in rabbits

Purpose

The aim of this study was to investigate the long-term histologic changes after bladder augmentation with gastric segment in an animal subject.

Materials and Methods

Gastrocystoplasty was performed in 13 young, 3-month-old male rabbits. Open biopsies were taken from the native bladder and the gastric segment preoperatively and at 3, 6, and 12 months postoperatively. Sections were examined with H&E and periodic acid-Schiff (PAS) staining. Indirect immune peroxidase method was additionally applied to detect the carcinoembrionic antigen, the proliferative activity, and the gene for the tumor protein p53 in the epithelium.

Results

On the native bladder, at the 3-month follow-up, polyps, mucosal edema, submucosal fibrosis, and squamous cell metaplasia were detected, which did not change during the follow-up. On the gastric segment, at the 3-month follow-up, parietal cell hyperplasia and inflammatory mucosal overgrowth were detected; at the 6-month follow-up, inflammation or atrophy of the gastric mucosa and colonic-type metaplasia was found. These alterations remained unchanged during later course of follow-up. Neither dysplasia nor malignancy was observed during the 12-month follow-up.

Conclusions

The present study supports the clinical observations of low cancer risk after gastrocystoplasty and may indicate different effect of gastric secretion on uroepithelium and that of urine on gastric mucosa.     

Long term effects of gastrocystoplasty in rats

Twenty prepubescent rats underwent microsurgical gastrocystoplasty by a technique which is described. An equal number of control rats had their bladders opened and closed. Rats were sacrificed at 16 to 18 months postoperatively. There were no differences in final weight, serum electrolytes, or renal function between the two groups. Prominent histopathologic changes of the bladder occurred in the gastrocystoplasty group. These changes included papillomas present in five of the 15 rats surviving long term. No significant changes occurred in the bladders of the control group of rats. Possible etiologies and the significance of the rats. Possible etiologies and the significance of the gastrocystoplasty related lesions are discussed.     

Histological findings after colocystoplasty and gastrocystoplasty

PURPOSE: We conducted a prospective, long-term assessment of the histological changes that can occur following bladder augmentation with colon or stomach. MATERIALS AND METHODS: Histological evaluations of biopsies from 44 consecutive patients undergoing augmentation (colocystoplasty in 26, gastrocystoplasty in 18) were performed. Patients underwent endoscopic assessment and tissue sampling at 2 or 4-year intervals following the initial augmentation procedure. Patients with less than 2 years of followup were excluded from the analysis. Specimens were taken from the native bladder, the augment segment (large bowel or stomach) and the anastomotic line. Sections (4 mu.) were examined using standard histological staining methods (hematoxylin and eosin and periodic acid-Schiff) and immunohistochemistry was performed for different markers of neoplasia, cellular proliferation and blood group antigens. Histological findings were correlated with the incidence of stone formation and urinary tract infection. RESULTS: Group 1 consisted of 20 patients undergoing colocystoplasty who met the criteria for study inclusion. Of the patients 10 (50%) had stones, 19 (95%) had a positive urine culture and 6 had no histological changes. While no cases of malignancy were identified, other forms of pathological change were noted in 14 of the 20 patients (70%). Group 2 included 15 patients undergoing gastrocystoplasty who met the criteria for study inclusion. No stones or malignancy were identified in this group. Positive urine cultures were recorded in 2 patients (13%), no histological changes were found in 6 and 9 (60%) had pathological changes. CONCLUSIONS: Periodic prospective biopsy evaluation of children who have undergone either colocystoplasty or gastrocystoplasty failed to reveal any histological evidence of malignancy after 10-year followup. However, histological evidence of a premalignant lesion 13 years after followup suggests that screening for premalignant lesions should be initiated no later than 6 to 10 years following enterocystoplasty.     

胃代膀胱术24例报告

１９９１年５月－１９９４年１２月行胃代替膀胱术２４例，其中膀胱移行细胞癌２１例，结核性膀胱挛缩２例，膀胱平滑机肉瘤１例。肿瘤患者行全膀胱切除术，１９例行胃膀胱成形术，３例行可控性低压胃膀胱术，结核性膀胱挛缩２例行胃扩大膀胱术，随访４－３９个月，３例死于肿瘤转移，２１例饮食健康良好，恢复工作。１８例经尿道排尿，每２４小时５－１０次，每次尿量３５０－８００ｍｌ，剩余尿０－３０ｍｌ，２例超过５０ｍｌ。肾     

Anaplastic signet ring cell carcinoma arising in gastrocystoplasty

Augmentation cystoplasty operations using segments of gastrointestinal tract are often necessary in neurogenic low-compliance bladders. Patients are usually rehabilitated with an increase in storage volume and normalization of the reduced compliance. However, gut mucosa-related early and late complications are not very uncommon. Malignancy, although rare, is known to occur after enterocystoplasty, but only one such case has been reported for gastrocystoplasty, a single patient who developed urothelial carcinoma. We describe what we believe to be the first case of signet ring cell carcinoma developing after gastrocystoplasty.     

Histological changes following two-step flap gastrocystoplasty in rats.

INTRODUCTION: A gastric segment used to increase bladder capacity can undergo considerable changes over time, as can all intestinal segments implanted in the urinary tract and in contact with urine. This experimental study reports the differences between the histological alterations observed in the gastric patch transposed in the bladder both with its own pedicle and after deafferentation from the stomach. MATERIALS AND METHODS: A group of 30 young male Sprague-Dawley rats underwent gastrocystoplasty. Survivors were divided into 3 groups: gastrocystoplasty alone (8 rats); gastrocystoplasty with vascular deafferentation at 15 days (7 rats), and at 2 months (8 rats). 5 rats were used as controls. Urinary pH was evaluated during a 6-month follow-up. RESULTS: Histology showed that early devascularization hindered the fusion of the two mucosae in the junctional area but reduced papillary hyperplasia (p = 0.013) of the gastric mucosa. No changes were observed in urinary pH after patch devascularization. CONCLUSIONS: Vascular deafferentation creates a gastric flap on the bladder which, even if it does not prevent urinary acidification, reduces the frequency of histologically detected changes susceptible for transformation into neoplasms.