Reducing mucus production after urinary reconstruction: A prospective randomized trial

Purpose: After transposition into the urinary tract, intestinal segments co ntinue to produce mucus. We determine the effectiveness of muco-regulatory drugs, including N-acetylcysteine, aspirin and ranitidine, in reducing mucu s secretion and urine viscosity in patients with transposed segments. Materials and Methods: Our trial was a prospective randomized, double-blind placebo controlled crossover study involving 12 patients who underwent ile al conduit and 31 who underwent bladder reconstruction, Each treatment last ed 3 weeks with a a-week washout. Pretreatment and posttreatment 24-hour ur ine samples were analyzed for mucin and viscosity after papain digestion, s odium dodecyl sulfate-polyacrylamide gel electrophoresis and periodic acid- Schiff assay. A disease specific questionnaire and SF-36 quality of life su rvey were completed. Results: According to the questionnaire, mucus production did not decrease with time in 67% of patients. Mucin comprised 3% of the total nondialyzable material in urine (65 mg./24-hour for ileal conduit and 60 mg,/24-hour for bladder reconstruction). Analysis of questionnaires and laboratory results failed to demonstrate any benefit of taking muco-regulatory agents compare d with placebo. Conclusions: The use of N-acetylcysteine, aspirin and ranitidine did not re sult in a reduction in mucin production, urine viscosity or improvement in quality of life.