Bowel Dysfunction After Transposition Of Intestinal Segments Into The Urinary Tract: 8-Year Prospective Cohort Study

UroToday.com- The ideal choice for replacing or improving the function of the lower urinary tract has yet to be developed. The current choices employ bowel segments in a variety of ways as conduits, continent diversions, or bladder augmentations. The indications for these procedures are bladder cancer, neurogenic bladder dysfunction, detrussor overactivity, and chronic inflammatory conditions of the bladder including interstitial cystitis. The use of bowel segments is not without complications however.

A recent review by B. K. Somani, J. N’Dow and colleagues from the Aberdeen and Newcastle, United Kingdom examined the consequences of employing bowel segments for the reconstruction of the lower urinary tract. The review is published in the May 2007 issue of the Journal of Urology.

The study group in this 8-year prospective study was 116 patients. A total of 96 patients (83%) completed the 8-year follow-up questionnaires including, 43 after ileal conduit diversion (group 1), 17 after clam enterocystoplasty for overactive bladder (group 2), 18 after bladder reconstruction for neurogenic bladder dysfunction (group 3), and 18 with bladder replacement for non-neurogenic causes (group 4). The severity of bowel symptoms and quality of life was assessed using 2 validated questionnaires.

Analysis of the results revealed that patients treated with clam enterocystoplasty (group 2) reported the highest prevalence of troublesome diarrhea (59%) with 50% on antidiarrheal medication. They also had high rates of fecal incontinence (47%), fecal urgency (41%), and abnormal bowel movements (18%). A large number reported an adverse effect on work (36%), social life (50%), and sexual activity (43%). High rates were also reported by patients with neurogenic bladder dysfunction including, 50% with troublesome diarrhea. This symptom was reported by 19% after ileal conduit and by 17% after bladder replacement for non-neurogenic indications.

In conclusion, after more than 8 years operations involving transposition of intestinal segments continue to be associated with high rates of bowel symptoms which impact everyday activities. These seem particularly troublesome following enterocystoplasty for overactive bladder and bladder reconstruction for neurogenic bladder dysfunction. These risks should influence patient selection and potential patients should be warned prior to undergoing these surgeries.

Somani BK, Kumar V, Wong S, Pickard R, Ramsay C, Nabi G, Grant A, N’Dow J, ABACUS Research Group

J Urol. 177(5):1793-8, May 2007
doi:10.1016/j.juro.2007.01.038

Reported by UroToday.com Contributing Editor Michael J. Metro, M.D

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