Adenocarcinoma arising at the ileoileal anastomotic site of Scheele''s ring

Most tumors arising after augmentation ileocystoplasty have been reported to develop adjacent to the ileovesical anastomosis. Herein, we report a case of adenocarcinoma arising at the ileoileal anastomotic site 33 years after augmentation ileocystoplasty (Scheele's ring plasty) for tuberculous contracted bladder. The present case shows the possibility of late malignancy developing at the ileoileal junction after ileal neobladder.     

Adenocarcinoma of the ileal segment 40 years after ileocystoplasty: a case report

We reported a case of ileal segment adenocarcinoma arising in the augmented bladder 40 years after the operation. The patient was a 57-year-old man who underwent ileocystoplasty (Goodwin method) for contracted bladder due to tubercurosis in 1962. He was referred to our clinic for examination of gross hematuria. Cystoscopy revealed a tumor on the ileal segment of the augmented bladder. He underwent resection of the ileal segment and ureterocutaneostomy. The pathological diagnosis was poorly differentiated adenocarcinoma in the ileal segment. He died of the disease 6 months after the operation.     

Adenocarcinoma of the ileal segment with transitional cell carcinoma of the bladder following ileocytoplasty: a case report

A 67 year-old woman visited our hospital complaining of pollakisuria. She had undergone left nephrectomy and augmentation ileocystoplasty for tuberculous bladder atrophy 40 years previously. She underwent a total cystectomy and tubeless ureterocutaneostomy with a preoperative diagnosis of muscle-invading transitional cell carcinoma of the bladder. The pathological diagnosis was adenocarcinoma of the ileal segment and transitional cell carcinoma of the original bladder. This is the first case report of adenocarcinoma of the ileal segment and transitional cell carcinoma of the original bladder among 22 patients suffering from bladder cancer after ileocystoplasty.     

Post-augmentation bladder perforation during urodynamic investigation

AIMS: To report for the first time bladder rupture during filling cystometry many years after bladder augmentation. METHODS: A 17-year-old girl with T10 meningomyelocele had received an ileocystoplasty, continent catheterizable stoma, and bladder neck sling for neurogenic bladder dysfunction and intractable incontinence 8 years previously. She was continent with clean intermittent self-catheterization four times per day. Yearly urodynamics showed a bladder capacity of up to 700 ml with good compliance and low bladder pressures. In March 2006, filling cystometry was performed. RESULTS: Bladder pressure was normal until 400 ml, after which it increased due to lower compliance. At 620 ml filling, the detrusor pressure was 52 cm H2O, and the patient complained suddenly of abdominal discomfort and bilateral shoulder pain, and the infusion was stopped. A catheter was placed and cystography showed intraperitoneal leakage along the left lateral bladder aspect and at the Mitrofanoff insertion site on the bladder dome. The perforations were closed via a midline incision and a ventriculoperitoneal shunt had to be exteriorized. There were no post-operative complications and a control cystogram revealed no leakage. CONCLUSIONS: Augmentation ileocystoplasty has been used extensively in order to increase bladder capacity and decrease intravesical pressure. Although spontaneous or traumatic perforation of the augmented bladder has been described previously, it was never reported in correlation with urodynamic investigation. Extreme caution is warranted in the face of decreased compliance during filling cystometry in these patients, even though urodynamics showed good bladder compliance and low bladder pressures many years after ileocystoplasty.     

Tubulovillous adenoma developing after urinary reconstruction using ileal segments

A case of tubulovillous adenoma arising in an augmented bladder is described. Ureteroileal substitution and ileocystoplasty was performed when the patient was 18 years old. She noticed gross hematuria 44 years after the surgery. Cystoscopy revealed a non-papillary multiple tumor at the site of ileovesical anastomosis and transurethral resection biopsy was performed. Histopathological examination revealed a tubulovillous adenoma. A tubulovillous adenoma developing at the augmented bladder is rare. To our knowledge, this is the second case in which a tubulovillous adenoma developed in an augmented bladder.     

Abdominoperineal excision of male lower urinary tract for synchronous adenocarcinoma of urethra and urinary bladder

Urethral adenocarcinoma is the least common histologic subtype of a rare primary carcinoma of the male urethra. Its site of origin remains speculative. The scarcity of reported cases in the literature makes it difficult to define the optimal management. This report is of a 40-year-old morbidly obese man with synchronous adenocarcinoma of the bulbar urethra and bladder, treated surgically by en bloc abdominoperineal penoprostatocystectomy. The pleural recurrence, after a disease-free period of 2 years, responded well to platinum-docetaxel-based systemic chemotherapy. Synchronous occurrence of adenocarcinoma of the urethra and bladder has not been previously reported. This case also highlights the possible role of upcoming adjuvant chemotherapeutic agents.     

Carcinomatous degeneration on augmentation ileocystoplasty for tuberculous bladder

The development of cancer on the ileal graft after augmentation ileocystoplasty for benign bladder disease is a little known complication. The authors report a case of squamous cell carcinoma in the ileal bladder occurring 37 years after augmentation ileocystoplasty for tuberculous bladder, in a 68-year old patient. Carcinomatous degeneration is usually occurs more than ten years after cystoplasty. Patients treated by this operation must be submitted to annual cystoscopy combined with guided biopsies at the slightest doubt. This surveillance should be started between the 5th and the 10th postoperative year.     

Adenocarcinoma of ileal neobladder 20 years after cystectomy

We present the case of a 67-year-old man with adenocarcinoma of the ileal neobladder 20 years after radical cystoprostatectomy for Stage pT2 transitional bladder cell cancer. A MEDLINE research revealed 9 other cases of the development of a neoplasm in the ileal part of an ileocystoplasty. This observation supports the hypothesis that in an ileal neobladder morphologic and molecular changes can be observed similar to those in the development of colorectal carcinoma. Patients who had an ileal neobladder created are at risk of glandular malignancy and should be closely followed up.     

Primary bladder adenocarcinoma in a young girl

We describe a case of primary adenocarcinoma of the bladder in an 18-year-old girl. She had no recurrence five years after operation. A young case is very rare because primary bladder adenocarcinoma are found mostly in old patients. We collected 86 cases of primary bladder adenocarcinoma in the Japanese literature, but found no case of a young patient in them. In the literature, epithelial bladder tumors in children have been reported to show good prognosis compared with adults.     

Clam ileocystoplasty: successful treatment of severe bladder overactivity

OBJECTIVE: When conservative treatment for bladder overactivity fails the "clam" ileocystoplasty has been proposed to restore continence and preserve urethral voiding. This study presents our experience with this technique. MATERIALS AND METHODS: Thirty patients, 4 men and 26 women, with a mean age of 50.3 years (range 21-71 years) were operated upon. Five patients had an incomplete spinal lesion and detrusor hyperreflexia, 25 subjects had an idiopathic, unstable detrusor. The ileocystoplasty was combined with a colposuspension procedure in 8 patients. In one patient simultaneous repair of an urethro-vaginal fistula was performed using omentum flap interposition. The mean follow-up was 60 months (range 4-127). RESULTS: To the surgeon, 27 patients (90%) reported satisfaction with bladder control and relief of symptoms at follow-up. When asked by a nurse in a written questionnaire, 18 out of 23 patients (78%) were quite happy with their bladder function postoperatively. No serious complications to surgery were noted. Postoperatively, 11 patients used self-intermittent catheterization and one, by choice, preferred an indwelling catheter. Due to failure, two patients later underwent reoperation with urinary diversion and one further patient required an additional artificial sphincter. Metabolic consequences owing to enteric malabsorption were infrequent and of a mild nature. No malignant change was identified. CONCLUSION: In patients with refractory overactive bladder, we found the "clam" ileocystoplasty to be an effective technique for symptom reduction and increased quality of life.     

A case of adenocarcinoma of the urinary bladder arising 45 years after ileal replacement of ureter for tuberculous ureteral stricture

We report a case of adenocarcinoma arising in the urinary bladder 45 years after ileal replacement of ureter for tuberculous ureteral stricture. A 65-year-old man was admitted with gross hematuria. Cystoscopic examination demonstrated a broadbased non-papillary tumor on the left posterior wall of the bladder and a papillary tumor at the anastomotic site between the bladder and ileal segment. Total cystectomy and construction of ileal conduit were performed. The histopathological examination demonstrated well differentiated adenocarcinoma of the bladder and ileal ureter. Intestinal metaplasia widely infiltrated into the bladder epithelium around the anastomotic site.     

膀胱次全切除回肠扩大膀胱术治疗神经源性膀胱尿道功能障碍

目的：探讨肠道扩大膀胱成形术治疗神经源性膀胱尿道功能障碍的价值。方法：采用膀胱次全切除、回肠扩大膀胱成形术治疗7例神经源性膀胱尿道功能障碍患者。结果：2例术后排尿通畅，剩余尿消失；3例术后曾有排尿困难，经尿道膀胱颈电切后排尿通畅，无尿失禁，最大尿流率分别为27、16和18ml/s；1例术前曾采用经尿道膀胱颈电切术无效，行本手术后剩余尿消失，但仍有尿失禁，后在超声引导下于尿道周围注射硅酮后，尿失禁症状明显改善；余1例术后仍有排尿困难。结论：该手术方法对神经源性膀胱尿道功能障碍是一种可行的治疗方法。     

A case of primary adenocarcinoma of the urinary bladder occurring in a patient with type 1 multiple endocrine adenomatosis (MEA)

A case of primary adenocarcinoma of the urinary bladder occurring in a patient with type 1 multiple endocrine adenomatosis (MEA) is presented. The patient was a 36-year-old female who had a past history of type 1 multiple endocrine adenomatosis, namely, adenomatosis of the parathyroid gland, insulin and gastrin-producing adenomatosis of the pancreas, and prolactin-producing pituitary adenoma. She was admitted in January 1981 with the complaints of gross hematuria, pollakisuria and micturition pain lasting for about one year and a half. Cystoscopic examination revealed four solid tumors in the posterior and left lateral walls of the bladder with diffuse mucosal hyperemia. Biopsy of the tumors disclosed that they were adenocarcinoma. Clinical examinations revealed that there was no extravesical primary malignant neoplasm in this case. Radical cystectomy with urinary diversion by ileal conduit was performed on January 22, 1981. Histological examination revealed that the tumor was adenocarcinoma originating from the vesical mucosa. Follow-up for over three years since the time of surgery has not shown any sign of tumor recurrence or occurrence of extravesical malignant neoplasm. In addition, 28 cases of primary adenocarcinoma of urinary bladder in Japan reported during the last 25 years are reviewed and analyzed.     

Late uro-ileal cancer after incorporation of ileum into the urinary tract.

PURPOSE: Development of late uro-intestinal malignancy after bowel incorporation into the urinary tract is a constant long-term hazard, even in the absence of fecal material. We report 6 such cases. MATERIALS AND METHODS: A total of 350 patients treated with an ileal conduit, 260 with ileal replacement of the ureter and 55 with ileocystoplasty were evaluated and followed for a minimum of 4 years. The methods of evaluation included urine analysis for microscopic hematuria, urine culture, serum creatinine and abdominal ultrasonography. These evaluations were performed every 2 months after cystectomy for bladder cancer and every 6 months in other cases. Annual urinary cytology and excretory urography were done. Computerized tomography and/or magnetic resonance imaging was performed annually after radical cystectomy or if there was evidence of hematuria, ureteral obstruction or a filling defect in the bladder, pouch or conduit on excretory urography. Endoscopic evaluation was done in some cases. If malignancy was diagnosed chest x-ray and bone scintigraphy were performed. RESULTS: A total of 645 patients were evaluable. Of these patients late cancer developed at the uro-intestinal anastomotic site in 6 (0.9%), including 1 of 348 (0.3%) who underwent ileal conduit, 3 of 54 (5.5%) ileocystoplasty and 2 of 258 (0.8%) ileal replacement of ureter. The latent period "from the time of original surgery till the development of cancer" ranged from 4 to 32 years (mean plus or minus standard deviation 20.2 +/- 10.9). The pathological type of cancer was adenocarcinoma in 3 patients, transitional cell carcinoma 2 and squamous cell carcinoma 1. CONCLUSIONS: Late uro-intestinal malignancy in patients who underwent ileal incorporation in the urinary tract is a low but still distinct risk. Ileocystoplasty is more vulnerable to late uro-enteric cancer than ileal conduit and ileal replacement of ureter. Late malignancy can develop earlier than 10 years postoperatively. Therefore, annual surveillance by routine urine cytology postoperatively is advocated, particularly with enterocystoplasty.     

Tumour of the urinary bladder preceded by vesical leukoplakia

A case of urinary bladder carcinoma originating during leukoplakia persisting for 15 years is presented. In one patient subtotal cystectomy and ileocystoplasty were performed. Postoperative survival was seven years. The authors discuss the causes of the development of leukoplakia, and suggest various ways of therapeutic interventions according to the progress of the disease.     

阑尾或肠管可控输出道在神经源性膀胱治疗中的应用

目的：评价阑尾或肠管可控输出道在高反射性神经源性膀胱治疗中的应用价值。方法：采用阑尾输出道（Mitrofanoff法）治疗高反射性神经源性膀胱患者4例,采用回肠腹壁造口（Yang-Monti法）治疗2例。3例采用膀胱自扩大,同时行阑尾输出道2例,回肠腹壁造口1例;3例行回肠膀胱扩大,同时采用阑尾腹壁造口2例,回肠腹壁造口1例。结果：术后随访3～39个月（平均20个月）。1例采用回肠扩大阑尾VZQ造口的患者术后2周造口部皮瓣感染坏死,改行阑尾直接造口;1例阑尾输出道出现造口部位漏尿,缩短导尿间隔为2h,漏尿消失;其他患者控尿良好。5例术后肾功能恢复正常,1例保持稳定。结论：阑尾或回肠可控输出道在高反射性神经源性膀胱治疗中是一种安全可靠的方法。     

Primary Adenocarcinoma in an Ileal Conduit

Reports of primary small intestine malignancies are rare. Even more uncommon is primary carcinoma in an ileal conduit. Here, we report a case of primary adenocarcinoma in an ileal conduit that developed 14 years after radical cystectomy and diversion to an ileal conduit for transitional cell carcinoma of the bladder. To our knowledge, only one case of primary adenocarcinoma developing in an ileal conduit after a radical surgery for bladder cancer has been reported previously.     

Cancer induction by urinary drainage or diversion through intestinal segments?

Since the introduction of ureterosigmoidostomy 79 cases of adenocarcinomas of the sigmoid near the implantation site of the ureters were described. Clinical and experimental data indicate that the excretion of urine and faeces together leads to endogenous nitrosamine synthesis and thus induces carcinomas. Other factors--like carcinogens excreted with the urine or chronic irritation of the mucosa by urine--could also cause carcinomas in the urine diverting parts of the intestine. Based on our own cases and a study of the literature we investigated whether other forms of urinary diversion can induce tumors. So far 4 tumor cases in ileum conduits and 2 cases in colon conduits have been reported together with 2 tumors in bladder augmentation (ileocystoplasty). We found in our material 1 case of cancer in a rectum bladder, 1 in a colocystoplasty, and 2 after ureterosigmoidostomy. In ureter substitution plasty and following Kock- or Camey-technique no cases of tumor induction have been reported so far. From the presently available data it must be concluded that urinary diversion using intestine may cause tumor induction. With the interval between surgery and evidence of tumor being at least 20 years a sharp increase in morbidity must be expected for the years after 1990. This leads to the demand that all patients with urinary diversion using intestine must be regularly evaluated by radiological, endoscopic and bioptic controls. These oncological aspects should be considered for the appropriate choice of urinary diversion especially in children.     

Intestinal volvulus after enterocystoplasty: report of three cases in children

Enterocystoplasty complications related to the presence of intestinal mucous presence in the bladder are well known and well reported in the literature. Mechanical problems in the intestinal tract due to using gut for bladder augmentation are not as well recognised. We analyzed three cases of children treated by ileocystoplasty who presented an intestinal volvulus in two cases and a cecal volvulus in one case around the vascular pedicle of the intestinal patch used for bladder augmentation.     

Cancer of the colon following ureterosigmoidostomy or following bladder enlargement using a colonic graft

The role of carcinogenic factors following urinary diversion are here studied on the basis of three very different cases. In the first, an adenocarcinoma developed at the site of a ureterocolic anastomosis thirty one years after Coffey's operation for bladder exstrophy. In the second, the tumor had developed, 31 years after uretero-sigmoidostomy, for ureteral trauma. The anastomosis had moreover ceased to function ten years previously. In the third case, the patient had undergone a right nephrectomy for urinary tuberculosis and a colocystoplasty to enlarge the bladder with re-implantation of the left ureter in the graft. Twenty one years later, an adenocarcinoma developed at the site of the anastomosis between the colonic graft and the bladder. This was an exceptional case (possibly the first) of a cryptal tumor developing out of contact with material. It thus runs counter to the alleged role of facies in the development of adenocarcinomas following urinary diversion.