LATE MALIGNANCY IN BOWEL SEGMENTS EXPOSED TO URINE WITHOUT FECAL STREAM

Objectives. This study was constructed so as to screen malignant trans formation after uroenteric reconstructions using bowel segments expose d to urine without fecal stream for more than 10 years. Methods. Follo w-up data were available for 186 patients who underwent various uroent eric reconstructions using bowel segments exposed to urine without fec al stream for more than 10 years. There were 68 eligible patients with isolated rectosigmoid bladder, 23 with bladder augmentations (15 ileo cystoplasty and 8 colocystoplasty), 57 with ileal ureter, and 38 with ileal loop conduit. Besides routine laboratory and radiologic investig ations, urine for cytology was obtained from all patients. Moreover, e ndoscopy and random biopsy of the part of bowel exposed to urine were carried out in all patients. Results. Uroenteric malignancy was diagno sed in 4 patients (2%): 2 adenocarcinoma in an isolated rectosigmoid b ladder, 1 transitional cell carcinoma following augmentation colocysto plasty, and 1 squamous cell carcinoma after ileal ureter. None of the patients developed tumors in ileal loop conduits. Conclusions. Maligna nt changes do not only occur after ureterosigmoidostomy but are also o bserved after different uroenteric reconstructions not exposed to feca l stream. Hematuria, ureteral obstruction, and abnormal urine cytology are warning signs of malignancy. Routine cytology is recommended at l east yearly beginning 10 years after surgery.