Reducing mucus production after urinary reconstruction: a prospective randomized trial.
OBJECTIVE
After transposition into the urinary tract, intestinal segments continue to produce mucus. We determine the effectiveness of muco-regulatory drugs, including N-acetylcysteine, aspirin and ranitidine, in reducing mucus secretion and urine viscosity in patients with transposed segments.


METHODS
Our trial was a prospective randomized, double-blind placebo controlled crossover study involving 12 patients who underwent ileal conduit and 31 who underwent bladder reconstruction. Each treatment lasted 3 weeks with a 2-week washout. Pretreatment and posttreatment 24-hour urine samples were analyzed for mucin and viscosity after papain digestion, sodium dodecyl sulfate-polyacrylamide gel electrophoresis and periodic acid-Schiff assay. A disease specific questionnaire and SF-36 quality of life survey 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 compared with placebo.


CONCLUSIONS
The use of N-acetylcysteine, aspirin and ranitidine did not result in a reduction in mucin production, urine viscosity or improvement in quality of life.
N'Dow
J
J
Departments of Surgery, Physiological Sciences and Statistics, University of Newcastle upon Tyne, Newcastle upon Tyne, England.
Robson
C N
CN
Matthews
J N
JN
Neal
D E
DE
Pearson
J P
JP
D000111:Acetylcysteine / Q000008:administration & dosage*; D000283:Administration, Intravesical; D000284:Administration, Oral; D001241:Aspirin / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D006801:Humans; D007082:Ileum / Q000601:surgery; D007413:Intestinal Mucosa / Q000378:metabolism*; D009077:Mucins / Q000378:metabolism / Q000652:urine; D009093:Mucus / Q000187:drug effects / Q000378:metabolism*; D011446:Prospective Studies; D011788:Quality of Life; D011899:Ranitidine / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000601:surgery*; D014547:Urinary Diversion; D014783:Viscosity / Q000187:drug effects
D009077:Mucins; D011899:Ranitidine; D001241:Aspirin; D000111:Acetylcysteine