Morphological changes on the intestinal mucosa in orthotopic neobladder.

INTRODUCTION: The intestinal mucosa undergoes significant atrophic changes when it is used to reconstruct the urinary tract. We analyzed the ultrastructural changes of intestinal mucosa in the orthotopic neobladder on the basis of our clinical experience. PATIENTS AND METHODS: Fifteen male patients with an ileal neobladder underwent endoscopic biopsy at different postoperative intervals. RESULTS: No significant changes were observed 3 months after surgery. After 6 and 12 months, the structure of the microvilli was modified significantly. No other substantial changes after 24 months were observed. CONCLUSIONS: Progressive modifications occur in the cytoplasmic structures involved in the absorptive process. They do not seem to begin before 3 months and are almost totally completed after 1 year.

Colonic metaplasia in the long-term follow-up of the ileal neobladder.

OBJECTIVE: To look for the presence of colonic metaplasia (CM), the shifting from sialomucins (SIs) to sulfomucins (SUs), considered as a probably premalignant lesion in the stomach in the mucosa of the ileal neobladder (IN). METHODS: 19 patients with IN were subjected to endoscopic biopsy; the samples were analyzed by means of histochemistry with high iron diamine, a test indicated to identify SIs and SUs. RESULTS: CM was never observed earlier than 1 year after the operation, was absent in 9/19 patients (mean follow-up 14 months) and present in 10/19 (mean follow-up 59 months). CONCLUSION: Time-dependent phenotypic changes, already described in the stomach as being premalignant, take place after constant contact with urine in the mucosa of the IN. It is at present unclear whether they may be defíned as only metaplastic or frankly preneoplastic; anyway, a careful follow-up remains indicated in all patients with íntestinal urinary diversions.

[Phenotypic changes in mucin-secreting cells in the ileal neobladder mucosa: a metaplastic or precancerous lesion?]. / Modificazioni fenotipiche delle cellule mucino-secernenti nella mucosa delle neovesciche ileali: lesione metaplastica o precancerosa?

Colonic metaplasia with shifting from sialo-to sulfomucins was observed in 10/18 patients with ileal orthotopic neobladder; their median follow-up was 59 months. There is a significant statistical relationship (p = 0.002) between Colonic Metaplasia and a follow-up longer than 14 months. Diversion Cancer is nowadays a practical problem and probably urologists will be confronted with it in the future more than at present. A modification of established attitudes as regards urinary diversion in standard situations (i.e., 60 over years old patients with invasive bladder cancer) don't seems, at present, justified, although our study confirms the suspicion that ileal neobladder could be considered theoretically at risk for cancer onset.

Ultrastructural mucosal appearance in the ileal neobladder.

METHODS: 15 patients with ileal neobladder underwent endoscopic biopsy at different postoperative intervals. The specimens were analyzed by electron microscopy in order to evaluate the evolution of the mucosal changes ultrastructurally. RESULTS: No significant change was observed 3 months after the operation. After 6 months, the number and height of the microvilli were reduced, the cell borders crooked and the terminal web upset. After 12 months disappearance of the glycocalyx, increased lysosomal features, increased activity of the muciparous cells, rounded mitochondria and loss of the polarized disposition of the cytoplasmic organelles were detected in the enterocytes. We observed no other substantial change after 24 months and more. CONCLUSIONS: Progressive modifications occur in the cytoplasmic structures involved in the absorptive process. They do not seem to begin before 3 months and are almost totally completed after 1 year.

Self-introduction of foreign bodies into the urethra: a multidisciplinary problem.

A 36-year-old man was hospitalized for self-insertion of a metallic body into the urethra. The self-inserted foreign body (SFB) was removed by endoscopic means; psychiatric evaluation of the patient showed a disturbed schizoid personality. After a review of the current literature, including clinical features, diagnostic manoeuvres and methods of treatment of SFB, the authors suggest that a psychiatric evaluation is always recommended in order to discover mental underlying disorders, thus reducing the risk of recurrence.

Focal xanthogranulomatous pyelonephritis: diagnostic and therapeutic aspects.

The authors report 2 cases of localized xanthogranulomatous pyelonephritis (XGP) in which computed tomography (CT) permitted to raise a motivated clinical suspicion of inflammatory disease: the surgical exploration documented absence of neoplasm and allowed a conservative therapy implying only the removal of the mass. A literature review confirms that some CT signs in XGP permit differentiation from carcinoma. If they are present, in unifocal cases of disease, the authors suggest a limited surgical approach and a therapeutic strategy as conservative as possible.

[Cystectomy and internal urinary diversion in bladder neoplasm. Role of CT in the follow-up]. / Cistectomia e diversione urinaria interna per neoplasia vescicale. Ruolo della TC nel follow-up.

Fifty-seven patients, with prior cystectomy and continent urinary diversion for transitional cell carcinoma of the bladder, were evaluated with CT. Forty-two of them presented ureterosigmoidostomy and 15 orthotopic ileal bladder. The CT appearance of the normal post-cystectomy pelvis is emphasized. Both early and late surgical and neoplastic complications were detected. Early surgical complications, including urinary fistulae, urinomas, seromas, lymphoceles, and abscesses, were diagnosed over a 6-month postoperative period. Late surgical complications included hydroureteronephrosis, calculosis, and pyelonephritis. Hydroureteronephrosis, due to stenosis of the ureteral anastomosis, was the most frequent complication. All such neoplastic complications as local recurrence, lymphnode distant metastases, were identified. In 83% of cases they were observed over a 2-year postoperative period. Distant metastases in the upper abdomen were never detected. The authors' experience suggests the following as the optimal follow-up: a) CT examination over a 6-month postoperative period; b) yearly CT examinations and urography over 4 postoperative years; c) yearly US examination over the first 2 years after surgery, to depict renal pelvis dilatation. Skeletal scintigraphy is often necessary to detect metastatic bone lesions. It should be performed no later than 2 years after cystectomy.