Abstract
Eighty Wistar rats were randomized into two groups. In group 1 vesicosigmoidostomy with proximal colostomy was performed, in group 2, vesicosigmoidostomy. The total tumor incidence did not differ significantly (group 1 10/40, 25%; group 2 13/40, 32.5%). The tumor spectrum differed, with more adenocarcinomas in group 2 (11/40, 27.5% vs 4/40, 10%;P=0.047) and urothelial carcinomas only in group 1 (5/40, 2.5%). One hundred and ten other Wistar rats were randomized into three groups. Animals in group A received vesicoileosigmoidostomy, group B, two-step vesicosigmoidostomy with initial separation of urine and the urocolonic anastomosis, group C, vesicosigmoidostomy. Significantly fewer adenocarcinomas were observed in group A (2/40, 5%) than in group B (16/40, 40%,P<0.002) and group C (9/30, 30%;P<0.007). These results indicate a similar cancer risk in all continent forms of urinary diversion, at least via colon. Ileal interposition seems to be an effective carcinoma prophylaxis following ureterosigmoidostomy. The proliferative instability at the urointestinal anastomosis is crucial for the pathogenesis and prophylaxis of this form of carcinogenesis, whereas urine seems to play only a minor role.
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References
Badiola F, Manivel CJ, Gonzalez R (1991) Seromuscular enterocystoplasty in rats. J. Urol 146:559
Crissey MM, Steele GD, Gittes RF (1980) Rat model for carcinogenesis in ureterosigmoidostomy. Science 207:1079
Daher N, Gautier R, Abourachid H, Decaens C, Bara J (1988) Rat colonic carcinogenesis after ureterosigmoidostomy: pathogenesis and immunohistological study. J Urol 139:1331
Gennaro AR, Villanueva R, Sukonthaman Y, Vathanophas V, Rosemond GP (1973) Chemical carcinogenesis in transposed intestinal segments. Cancer Res 33:536
Gittes RF (1986) Carcinogenesis in ureterosigmoidostomy. Urol Clin North Am 13:201
Gregoire M, Kantoff P, DeWolf CW (1993) Synchronous adenocarcinoma and transitional cell carcinoma of the bladder associated with augmentation: case report and review of the literature. J Urol 149:115
Kälble T (1993) The risk of malignancy after cystoplasty. Cur Opin Urol 3:476
Kälble T, Tricker AR, Berger M, Amelung R, Waldherr R, Hothorn L, Möhring K, Staehler G (1991) Tumor induction in a rat model for ureterosigmoidostomy without evidence of nitrosamine formation. J Urol 146:862
Kälble T, Schreiber W, Berger MR, Waldherr R, Amelung F, Möhring K, Staehler G (1993) Risk of carcinoma in different forms of urinary diversion via intestine. Aktnelle Urol 24:1
Kim KS, Susskind MR, King LR (1988) Ileocecal ureterosigmoidostomy: an alternative to conventional ureterosigmoidostomy. J Urol 140:1494
Kingsnorth AN, King WK, Diekema KA, McCann PP, Ross JS, Malt RA (1983) Inhibition of ornithine decarboxylase with 2-difluoromethylornithine: reduced incidence of dimethylhydrazine-induced colon tumors in mice. Cancer Res 43:2545
Kliment J, Luptak J, Lofaj M, Horakova M, Beseda A (1993) Carcinoma of the colon after ureterosigmoidostomy and trigonosigmoidostomy for exstrophy of the bladder. Int Urol Nephrol 25:339
Kock GN, Mohamed AG, Lycke GK, Mahran RM (1988) Urinary diversion to the augmented and valved rectum: preliminary results with a novel surgical procedure. J Urol 140:1375
Marino BM, Vitale L, Kiss A, Rossi R, Drago GW (1994) Carcinoma of the large intestine following ureterosigmoidostomy in a patient with bladder exstrophy. Minerva Chir 49
Miersch WDE, Vogel J (1992) Induction of carcinoma at ureterosigmoid anastomosis—with and without faecal stream. Br J Urol 69:499
Rappolee AD, Mark D, Banda MJ, Werb Z (1988) Wound macrophages express TGF-alpha and other growth factors in vivo: analysis by mRNA phenotyping. Science 242:708
Reddy SB, Tokumo K, Kulkarni N, Aligia C, Kelloff G (1992) Inhibition of colon carcinogenesis by prostaglandin synthesis inhibitors and related compounds. Carcinogenesis 13:1019
Roe R, Fermor B, Williamson RCN (1987) Proliferative instability and experimental carcinogenesis at colonic anastomoses. Gat 28:808
Schuh AC, Keating J, Monteclaro FS, Vogt PK, Breitman ML (1990) Obligatory wounding requirement for tumorigenesis in v-jun transgenic mice. Nature 346:756
Spencer JR, Steckel J, May M, Marion D, Hernandez K, Vaughan ED Jr (1993) Histological and bacteriological findings in long-term ileocystoplasty and colocystoplasty in the rat. J Urol 150:1321
Strachan JR, Matthews J, Rees HC, Cooke T (1987) Kinetic changes in experimental colonic urinary diversion. Br J Surg 74:1046
Thun MJ, Mohan MD, Namboodiri M, Heath C Jr (1991) Aspirin use and reduced risk of fatal colon cancer. N Engl J Med 325:1593
Weber TR, Westfall SH, Steinhardt GF, Webb L, Avila CS, Conners RH (1988) Malignancy associated with ureterosigmoidostomy: detection by mucosa ornithine decarboxylase. J. Pediatr Surg 23:1091
Williamson RCN, Davies PW, Bristol JB, Wells M (1992) Intestinal adaptation and experimental carcinogenesis after partial colectomy. Gut 23:316
Young PR, Kreder KJ, Akwari O, Godfried M, Webster GD, Durham NC (1993) Carcinogenic potential in augmented bladders: a rat model. J. Urol 149:373A
Yura Y, Hayashi O, Kelly M, Oyasu R (1989) Identification of epidermal growth factor as a compenent of the rat urinary bladder tumor-enhancing urinary fractions. Cancer Res 49:1548
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Kälble, T., Busse, K., Amelung, F. et al. Tumor induction and prophylaxis following different forms of intestinal urinary diversion in a rat model. Urol. Res. 23, 365–370 (1995). https://doi.org/10.1007/BF00698735
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DOI: https://doi.org/10.1007/BF00698735