Increased urinary nitrosamine excretion in paraplegic patients.
An increased risk of bladder cancer is a recognized complication in spine-injured patients undergoing long-term urethral catheterization to preserve renal function. Aerobic cultures from 28 of 30 paraplegic patients showed complex bacterial flora containing nitrate-reducing organisms (Escherichia coli, Proteus and Klebsiella spp.). Urine samples from 29 paraplegic patients were also found to contain volatile nitrosamines. Mean N-nitrosamine excretion levels were 0.65 +/- 0.69 micrograms/day N-nitrosodimethylamine, 0.25 +/- 0.44 micrograms/day N-nitrosopiperidine and 0.39 +/- 0.50 micrograms/day N-nitrosopyrrolidine. A mean urinary nitrite excretion of 10.4 +/- 13.2 mg/day was found in 24 out of 30 paraplegic patients. In the sterile urine of control volunteers (medical staff attending the paraplegic patients and in-patients from other wards of the hospital), no urinary excretion of volatile N-nitrosamines and nitrite was found. The results clearly demonstrate a bacterially mediated in vivo formation of N-nitroso compounds in the urinary tracts of paraplegic patients which may be an important etiological risk factor for bladder cancer in this patient group.
Tricker
A R
AR
Institute of Toxicology and Chemotherapy, German Cancer Research Center, Heidelberg, FRG.
Stickler
D J
DJ
Chawla
J C
JC
Preussmann
R
R
D000588:Amines / Q000652:urine; D006801:Humans; D009566:Nitrates / Q000652:urine; D009573:Nitrites / Q000652:urine; D009602:Nitrosamines / Q000652:urine*; D010264:Paraplegia / Q000652:urine*; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000209:etiology; D014546:Urinary Catheterization / Q000009:adverse effects; D014556:Urine / Q000382:microbiology*
D000588:Amines; D009566:Nitrates; D009573:Nitrites; D009602:Nitrosamines