Ulcer perforation in gastric urinary conduit: Never use a gastric segment in the urinary tract if there are other options available

A male patient, who had had a conservatively treated hemorrhagic peptic ulc er 12 years earlier, underwent gastrocystoplasty after radical cystoprostat ectomy for carcinoma of the urinary bladder, After operation the patient su ffered urinary incontinence and dysuria which he found so bothersome that t he gastric bladder was converted to diversion using the same gastric segmen t as a tube. Postoperatively there were clots of blood in stomal urine and after the kidneys had been drained intestinal fluid oozed from the stoma, O n the 14th postoperative day the patient died of pulmonary embolism, The au topsy showed a perforated peptic ulcer in the gastric segment resulting in a closed fistula to the small bowel, Most probably the reason for developme nt of the peptic ulcer was stress caused by the operation and it might have been avoided by using hydrogen-blocking agents. This case seriously questi ons whether a gastric segment should be used in the urinary tract at all, a nd at least it should never be used as a conduit. Copyright (C) 2000 S. Kar ger AG, Basel.