Current status of tumor of the bowel following ureterosigmoidostomy: a review.
In the final analysis the major question that arises is whether urinary diversion to the intact colon should be performed at all for benign conditions in which a relatively long life expectancy may be anticipated. In answer to this question we believe that if exstrophy is the problem early primary closure with the staged reconstruction should be attempted first. If such efforts are marred by persistent incontinence management with an artificial urinary sphincter should be considered. In individuals with multiple bladder dehiscences after attempts at primary bladder closure, or in an individual with persistent incontinence despite multiple procedures surgical alternates should include diversion by a bowel conduit, continent urinary diversion, a variant of the ureterosigmoidostomy or standard ureterosigmoidostomy. Indeed, despite the appropriate concern regarding the development of tumor in ureterosigmoidostomy, this diversion may still have a major role in the educational process of urology throughout the next decade. Specifically, we must apply the knowledge gained from our clinical and laboratory investigations of ureterosigmoid diversion to the current more popular means of diversion. Of particular concern are the clinical findings of adenocarcinoma in enteric augmentations. This discovery must serve as a warning for the possibility of urocolonic tumors developing within alternative continent urinary diversions within the next 20 to 30 years. Certainly, at least annual evaluations of any diversions are mandatory until we can define accurately the morbidity and mortality arising from our interventional management.
University of Texas Southwestern Medical School, Dallas.
D A
DA
Husmann
H M
HM
Spence
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology; D001746:Bladder Exstrophy / Q000601:surgery; D002648:Child; D012809:Colon, Sigmoid / Q000601:surgery; D003111:Colonic Polyps / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008017:Life Expectancy; D012811:Sigmoid Neoplasms / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D014547:Urinary Diversion / Q000009:adverse effects*