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Thread: Bladder Augmentation & Cancer

  1. #1
    Senior Member
    Join Date
    May 2002

    Bladder Augmentation & Cancer

    Dear KLD
    Some months ago you advised me to have another Urodynamics. I had the procedure 4 days ago.The test proved the bladder and sphincter do not work in sequence. ie; when the bladder is full and contracts the sphincter becomes tight. The Urologist suggested two operations. [1] cut the sphincter. [2] Bladder Augmentation. The first suggestion is a worry as I have major problems wearing ext cath condom. The second suggestion the doctor said can cause cancer, could you confirm this.

    Further the doctor works for a large general hospital. He has performed both ops periodically when he worked in a spinal unit many years ago.

    I also have an appointment for another urodynamics study at a leading Spinal hospital ordered by an SCI Urologist. I had previously had a consult with him last April. He was concerned with AD. Because of his position there is always a long waiting time for any operation. Unlike the doctor I saw recently I only waited two weeks.

    I am confused by what to do. Would anything be gained with a second urodynamics, opinion? The first urodynamics took almost two hours the doctor was very thorough doing the test about 5 times. I have a copy of the report.

    As always any advice is appreciated.

    Pops. C5/6 incomplete 1976. Almost Ambulant

  2. #2

    Until you mentioned it, I had not been aware of any reports that bladder augmentation may be associated with cancer. It is rare. Here are all the studies that I have been able to find. One unanswered question for me is how much the previous conditions (necessitating the bladder augmentation) placed the patients at risk. Most of the reported cases have involved bladder augmentation for urinary tuberculosis which I assume that you don't have. Finally, I don't know the difference in the cancer rate of people who get and don't get the augmentation.


    • Qiu H, Kordunskaya S and Yantiss RK (2003). Transitional cell carcinoma arising in the gastric remnant following gastrocystoplasty: a case report and review of the literature. Int J Surg Pathol. 11: 143-7. Department of Pathology, UMass Memorial Health Care, Worcester, MA 01655, USA. Urinary bladder augmentation with segments of the stomach (gastrocystoplasty), small bowel, or large intestine (enterocystoplasty) improves capacity and compliance in patients with bladder dysfunction. Although malignant complications of enterocystoplasty have been reported, the risk of malignancy in the setting of gastrocystoplasty is not known. We describe the case of a 73-year-old woman who developed a transitional cell carcinoma associated with transitional cell metaplasia and dysplasia of the gastric epithelium 14 years following gastrocystoplasty. To our knowledge, this is the first reported case of a malignant complication of this surgical procedure. We conclude that patients who have undergone gastrocystoplasty are at an increased risk for the development of malignancy in the neobladder and require close long-term follow-up, similar to patients who have undergone enterocystoplasty.

    • Bono Arino A, Sanz Velez JI, Esclarin Duny MA, Berne Manero JM and Vera Alvarez J (2001). [Signet ring-cell adenocarcinoma in colocystoplasty]. Actas Urol Esp. 25: 312-4. Servicio de Urologia, Hospital San Jorge, Huesca. We report a case of signet ring-cell adenocarcinoma in augmentation colocystoplasty. We review the current literature about tumours developing in augmentation bladder.

    • Docimo SG, Chow NH, Steiner G, Silver RI, Rodriguez R, Kinsman S, Sidransky D and Schoenberg M (1999). Detection of adenocarcinoma by urinary microsatellite analysis after augmentation cystoplasty. Urology. 54: 561. James Buchanan Brady Urological Institute, Division of Pediatric Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Augmentation cystoplasty is associated with an increased risk of bladder cancer development between 10 and 20 years after augmentation. Using microsatellite analysis, we analyzed urine obtained before surgical resection of the malignant lesion from a patient who developed invasive adenocarcinoma after augmentation cystoplasty. Loss of heterozygosity was identified in both urine and tumor samples from this patient. This observation suggests that microsatellite urine analysis may be useful as a monitoring tool for patients after augmentation cystoplasty.

    • Ulmer M, Cormieu L and Hubert J (2000). [Carcinomatous degeneration of augmentation enterocystoplasty]. Prog Urol. 10: 450-5. Service de Chirurgie Generale et Digestive, Hopital de Brabois, Vandoeuvre, France. Augmentation enterocystoplasties are performed increasingly frequently and their indications are no longer exclusively limited to small tuberculous bladders. One of the most serious complications of these procedures is malignant transformation, as reported in the present case. Carcinomatous degeneration is uncommon and usually occurs more than ten years after enterocystoplasty. Patients treated by this operation must be submitted to annual cystoscopy combined with guided biopsies at the slightest doubt. This surveillance should be started between the 5th and the 10th postoperative year.

    • Lane T and Shah J (2000). Carcinoma following augmentation ileocystoplasty. Urol Int. 64: 31-2. Institute of Urology, The Middlesex Hospital, London, UK. Carcinoma of the bladder following augmentation cystoplasty is rare. Only 15 cases have been reported worldwide. We report a further 2 cases, 1 of which, a squamous cell carcinoma, has not previously been described in this context.

    • Cranidis A and Nestoridis G (2000). Bladder augmentation. Int Urogynecol J Pelvic Floor Dysfunct. 11: 33-40. Urological Clinic, University School of Medicine of Crete, Heraklion, Greece. This paper reviews bladder augmentation, which has been proved to be an effective way of providing a well functioning urine reservoir that protects the upper urinary tract and allows patients to have a good quality of life. Good results have been achieved with the use of all types of bowel segments. Lifetime follow-up and recognition of the complications is mandatory. Very careful patient selection is essential in order to achieve better long-term results. The principle of urothelial preservation, introduced by autoaugmentation, is very promising in the effort to create a compliant urinary reservoir without metabolic disturbance and without the risk of cancer.

    • Sato M, Fukui S, Fujita I, Kawakita M, Matsuda T, Sakaida N, Okamura M, Yamanaka K and Den S (2000). [Adenocarcinoma of the ileal segment with transitional cell carcinoma of the bladder following ileocytoplasty: a case report]. Hinyokika Kiyo. 46: 33-6. Department of Urology, Kansai Medical University. A 67 year-old woman visited our hospital complaining of pollakisuria. She had undergone left nephrectomy and augmentation ileocystoplasty for tuberculous bladder atrophy 40 years previously. She underwent a total cystectomy and tubeless ureterocutaneostomy with a preoperative diagnosis of muscle-invading transitional cell carcinoma of the bladder. The pathological diagnosis was adenocarcinoma of the ileal segment and transitional cell carcinoma of the original bladder. This is the first case report of adenocarcinoma of the ileal segment and transitional cell carcinoma of the original bladder among 22 patients suffering from bladder cancer after ileocystoplasty.

    • Shaw J and Lewis MA (1999). Bladder augmentation surgery--what about the malignant risk? Eur J Pediatr Surg. 9 Suppl 1: 39-40. The North West Regional Spina Bifida Registry, Manchester Children's Hospitals, Pendlebury, UK. Augmentation cystoplasty has become a common surgical treatment for the neuropathic bladder. However, malignancy in bladder augmentations has been well-described and in time is estimated to occur in 1.3% of cases. We surveyed 36 paediatric surgeons from the UK with a special interest in paediatric urology to ascertain how many bladder augmentations were being performed in children each year and whether the surgeons were warning patients/parents of the malignant risks involved with this surgery. Over 150 bladder augmentations were being performed in the UK each year. Surgeons surveyed were concerned about the malignant risks and nearly all agreed that a Central Registry of patients with bladder augmentations should be established to keep track of developments.

    • el Otmany A, Hamada H, al Bouzidi A, Oukheira H, Boujida M, Souadka A, Amrani M, Jahid A and Belabbas M (1999). [Squamous cell carcinoma in an augmentation of the ilial bladder for tuberculosis]. Prog Urol. 9: 534-6. Service de Chirurgie, Institut National d'Oncologie Sidi Mohamed Ben Abdellah, Rabat, Maroc. The development of cancer on the ileal graft after augmentation ileocystoplasty benign bladder disease is a little known complication. The authors report a case of squamous cell carcinoma in the ileal bladder occurring 31 years after augmentation ileocystoplasty for tuberculous bladder, in a 60-year-old patient. The ileal bladder was resected and a new augmentation ileocystoplasty was performed. The postoperative course was uneventful. Histological examination of the operative specimen showed infiltration of all of the intestinal wall. The patient died one year after, in a context of peritoneal carcinomatosis.

    • Yip SK, Wong MP, Cheung MC and Li JH (1999). Mucinous adenocarcinoma of renal pelvis and villous adenoma of bladder after a caecal augmentation of bladder. Aust N Z J Surg. 69: 247-8. Queen Mary Hospital, Hong Kong.

    • Yoshida T, Kim CJ, Konishi T, Yoshiki T, Park KI and Tomoyoshi T (1998). [Adenocarcinoma of the bladder 19 years after the augmentation ileocystoplasty: report of a case]. Nippon Hinyokika Gakkai Zasshi. 89: 54-7. Department of Urology, Shiga University of Medical Science. We report a case of adenocarcinoma of the augmented bladder 19 years after ileocystolasty. The patient was a 53-year-old man who underwent right nephrectomy and ileocystoplasty (Pyrah's method) for contracted bladder due to tuberculosis in 1965. In another hospital, transurethral resection (TUR) was performed against a tumor in the anastomotic site between the bladder and the ileal segment in 1996. Histopathological examination of the specimen obtained by TUR revealed poorly-differentiated mucinous adenocarcinoma. In our hospital, partial cystectomy with total resection of ileal segment and ileocystoplasty were performed. The tumors located in the anastomotic site between the bladder and ileal segment as well as in the ileal segment. Histopathological examination revealed poorly-differentiated mucinous adenocarcinoma. The patient has survived 12 months without any evidence of tumor recurrence. To our knowledge, this is the eighth case report in Japan.

    • Koizumi S, Johnin K, Kataoka A, Nakai M and Tomoyoshi T (1997). [Adenocarcinoma occurring 37 years after augmentation ileocystoplasty for tuberculous bladder atrophy: report of a case]. Hinyokika Kiyo. 43: 743-5. Department of Urology, Uji Tokusyukai Hospital. A 55-year-old woman was admitted with urinary frequency. She had undergone augmentation ileocystoplasty due to tuberculous bladder atrophy 37 years previously. Cystoscopy revealed a tumor on the posterior wall which had been augmented with the ileum. Partial cystectomy and bladder reconstruction using a segment of ileum and ascending colon were performed. Gross inspection showed a 15 x 10 mm, papillary tumor on the ileal mucosa near the vesico-ileal anastomosis. Histologically, moderately differentiated adenocarcinoma infiltrating into the muscle layer was surrounded by the normal ileal mucosa. She has been free of recurrence for 2 years postoperatively. This is the 8th case of adenocarcinoma following augmentation ileocystoplasty reported in the Japanese literature.

    • Cardini S and Smulevich E (1997). [Transitional carcinoma of the ureter and urinary tuberculosis]. Minerva Urol Nefrol. 49: 33-7. Ospedale Santa Maria Annunziata, II Unita Ospedaliera di Chirurgia Generale, Azienda Ospedaliera, Firenze. Tumors of the renal pelvis are rare neoplasms: their yearly incidence is 1.4 cases per 100,000 men and 0.6 cases per 100,000 women. The annual incidence of renal tuberculosis is 13 cases per 100,000 persons. The likelihood of both diseases occurring in the same kidney is extremely remote. We report on a case of ureter transitional cell carcinoma developed in a patient with tuberculosis stenosis of the same ureter, small retracted bladder and destruction of the opposite kidney. Total uterectomy, augmentation ileocaecocystoplasty and contralateral nephrectomy were performed. Literature is briefly reviewed and is underlined too the paradoxical simultaneous occurrence of transitional cell carcinoma and active tuberculosis infection, while the use of the bacillus of Calmette-Guerin is being advocated in the treatment of urotelial tumors.

    • Barrington JW, Fulford S, Griffiths D and Stephenson TP (1997). Tumors in bladder remnant after augmentation enterocystoplasty. J Urol. 157: 482-5; discussion 485-6. Department of Urology, University Hospital of Wales, Heath Park, Cardiff, South Glamorgan, United Kingdom. PURPOSE: We attempted to determine the tissue of origin of tumors after augmentation enterocystoplasty. MATERIALS AND METHODS: We retrospectively reviewed the histological findings of 4 tumors that developed after clam ileocystoplasty. RESULTS: Tumors were primarily adenocarcinoma that originated on the bladder side of the anastomosis. The urothelium showed glandular metaplasia and dysplasia with intestinalization overlying normal detrusor muscle. These changes were also present in the renal pelvis in 1 patient with ureteral reflux. Bowel mucosa was normal except for inflammation. CONCLUSIONS: These tumors are derived from urothelium, which may be due to elevated urinary nitrosamines in this group of patients.

  3. #3
    Down below I posted about my "Bladder Augmentation Fantastic." If you have any questions about any of the surgery and the after effects I would be glad to answer them. I never heard of any cancer problems.

  4. #4
    "The second suggestion the doctor said can cause cancer, could you confirm this. "

    i'm fairly certain this is not true. if anything causes bladder cancer, it's the long term presence of an indwelling catheter such as a foley or suprapubic

  5. #5
    There is a very small risk of cancer for any bowel associated urinary procedure. This has been seen in urinary diversions (ileal conduits, Bricker procedures, etc.) as well as augmentations, but the risk is very small, and as noted below, signficantly lower than the risk of an indwelling catheter which has significant association with bladder cancer long term. Smoking or other tobacco product use is also a major contributing factor, so anyone with a urinary diversion, indwelling catheter, or augmentation should be advised to stop use of tobacco immediately.

    I am concerned that he is only offering you these two options. DSD (detrusor sphincter dyssynergia) like this is quite common in people with SCI. What is your capacity and maximum pressure from your urodynamics? Has Botox been discussed as a possible option? How much Ditropan or Detrol are you taking currently? I assume you are doing intermittent cath. What is your present regimen? You are correct that a sphincterotomy or urethral stent should not be done if you cannot keep on an external catheter. What types have you tried? Are you overweight?

    I would definately get a second opinion before having any surgical procedure.


  6. #6
    KLD, would Botox reduce bladder spasms or completely eliminate them?

    ...child, when life don't seem worth livin', come to jesus and let him hold you in his arms

  7. #7
    This depends on how it is done (and by whom). Studies have shown that you can nearly paralyze the bladder using Botox, but repeated injections are needed, and the experience and skill of the urologist is critical.


  8. #8
    Senior Member
    Join Date
    May 2002
    Thank you all for your replies I shall try and answer your questions.

    KLD if I may start with you please.
    I self/cath 5 or 6 times a day and voluntarily void in between caths. I take Ditropan 5mg X 3 day. I thought my bladder capacity was 400 mls. This is generaly when AD starts. When that happens I will void 200mls then cath the residue 200mls.
    The Urologist was able to increase bladder volume to 800mls before I was able to urinate during the test. I assume the pressure reading you mentioned are E:P abd cmH2o =50
    D:P ves cmH2o =98
    D-E:P def cmH2o =80
    H:V fill ml 500
    I use wide band ext/cath that work well whilst laying down. Over weight by 20 pounds.

    Botox was discussed last April with SCI Urologist. I will obtain another opinion from him.

    Mary I will take you up on your offer thank you. Crags, Steven thank you I value your advice.

    Finally Doctor Wise Young what can I say your a saint.


  9. #9
    Your pressures are too high to be safe long term. Your residual is too high to not need to cath.

    Keep in mind that with both an augmentation or Botox treatment you would have to continue cathing, and may not void at all on your own.

    Your Ditropan dosage could be increased up to 30 mg. daily which might decrease or eliminate your voiding, decrease your pressures, and reduce your problems with AD. I would not consider a surgical procedure without trying this.


  10. #10
    @sci-nurse is Ditropan dosage bit high?

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