Indications and early and late results of intestino-cystoplasty: a review of 185 cases

Study on use of isolated segment of ileum in urological plastic operation

Studies were done on 33 cases of plastic reconstruction of the urinary tract with an isolated ileal segment. We found that electrolytes and other components in the urine can be absorbed or excreted by the isolated ileal mucosa. Although electrolyte balance was preserved in most cases the tendency for hyperchloremic acidosis and high blood urea nitrogen was observed in some patients with poor renal function. The degree and the incidence of these changes were influenced by the length of ileal segment used and the volume of urine excreted. These 2 factors were related to infection, which gave deleterious effects on renal function. Among the tests used for prognosis the excretory urogram was found to be the most simple and provided the best information.

Use of ileocystoplasty in the hypertonic neurogenic bladder

An ileocystoplasty was used successfully in the management of incontinence secondary to a hypertonic neurogenic bladder. The indications for its use and possible benefits in patients with neurogenic bladder have been discussed.

Adenocarcinoma developing in an ileocystoplasty

Multifocal adenocarcinoma and carcinoma-in-situ arising in the suture line of an ileocystoplasty are reported in a 52-year-old woman who presented with haematuria 15 years after bladder reconstruction for tuberculosis. An origin in the ileal mucosa was established by microscopy. There are similarities with a transitional-cell carcinoma in an ileocystoplasty which has recently been recorded. Both cases are related to tumours associated with ureterosigmoidostomy where the site, tumour types, and latent period are similar. Aetiological factors seem to include a long latent period (15 years or more) and possibly the direct action of urine, recurrent infection, and mucosal ulceration. It is concluded that all patients with gastro-intestinal urothelial anastomoses must be followed up indefinitely.