title: Adenocarcinoma in Continent Anal Urinary Diversion: Is a Sigma Rectum Pouch a Surgical Option After Failed Ureterosigmoidostomy?
abstract: OBJECTIVE
  To report our experience of radical resection of secondary cancers after ureterosigmoidostomy. Ureterosigmoidostomy was the most common continent urinary diversion before the era of continent cutaneous diversion and neobladders, specifically in children. When performed for bladder exstrophy, patients will live with this kind of diversion for quite a long time. As a result, urologists will be confronted with patients presenting with an adenocarcinoma in their ureterosigmoidostomy. In most cases reported in the literature, an ileal conduit was used for urinary conversion. However, nowadays an ileal loop must not be the only solution for patients with a long life expectancy.
  
  
  METHODS
  Between 2004 and 2015, 6 patients were treated for an adenocarcinoma in their ureterosigmoidostomy. All patients underwent radical resection of the tumor-bearing sigmoid colon. After thorough preoperative informed consent concerning the choice of future urinary diversion, such as conversion to an ileal conduit, construction of a continent catheterizable pouch, or repeat continent anal diversion, 4 patients chose a repeat continent anal urinary diversion.
  
  
  RESULTS
  Up to this date, no complications or recurrences were seen after a median follow-up of 35 months.
  
  
  CONCLUSIONS
  In patients with secondary malignancy of the colon, radical resection of the tumor-bearing bowel segment is mandatory. A repeat continent anal urinary diversion appears to be a feasible alternative to secondary urinary diversion after resection of the tumor-bearing sigmoid colon. However, a longer follow-up is required to determine whether the risk of secondary malignancy remains unchanged, and whether the risk is increased or decreased.
authors.affiliation: Department of Urology, University Hospital Mannheim, Mannheim, Germany. Electronic address: Patrick.honeck@medma.uni-heidelberg.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Honeck
authors.affiliation: Department of General Surgery, University Hospital Mannheim, Mannheim, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kienle
authors.affiliation: Department of Urology, University Hospital Mannheim, Mannheim, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Huck
authors.affiliation: Department of Urology, University Hospital Mainz, Mainz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Neisius
authors.affiliation: Department of Urology, University Hospital Mannheim, Mannheim, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Thüroff
authors.affiliation: Department of Pediatric and Adolescent Urology, University Hospital Mannheim, Mannheim, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Stein
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery; D000328:Adult; D012809:Colon, Sigmoid / Q000473:pathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D012086:Reoperation / Q000379:methods*; D012811:Sigmoid Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery; D014521:Urethra / Q000473:pathology / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods; D016476:Urinary Reservoirs, Continent