Fig. 11.1
Follow-up of bladder augmentations and neobladder formation after reconstruction for benign urologic conditions
Is there a need for cystoscopic surveillance in specific patient categories, e.g., patients following gastric augmentations, or patients with a history of bladder augmentation following renal transplantation?
The published literature strongly suggests that individuals undergoing a gastric augmentation (2.5-fold increased risk) and individuals with a history of bladder augmentation undergoing a renal transplantation (sixfold to tenfold increased risk) have a significantly higher risk of developing a malignancy compared to an individual undergoing a augmentation without this surgical history [17, 18, 27, 29, 32, 34, 38]. In view of these findings the question arises should we routinely place these select patient populations under cystoscopic surveillance? Although we would strongly recommend that we routinely follow these individuals on an annual basis on the protocol outlined above, we do not alter our routine surveillance protocol to include annual cystoscopy for these specific patient populations. This recommendation is based on the hypothesis that routine cystoscopic surveillance would not meet the definition of a successful surveillance protocol, due to the aggressive nature of the primary malignancy and the low sensitivity and specificity of cystoscopy [3, 15, 17, 18, 21, 22, 25, 39].
Conclusion
Annual screening endoscopy and cytology in patients with bladder augmentation or continent urostomy for congenital urological disease is not recommended due to their poor sensitivity, unproven specificity, cost-ineffectiveness, and inability to diagnose a low-stage malignancy. Surveillance of this patient population is, however, recommended to prevent the associated serious complications that can lead to upper urinary tract destruction, metabolic, and vitamin derangements following these procedures. The onset of new clinical symptoms and/or abnormal serial baseline serum chemistries or radiographic findings, should, when indicated prompt further evaluations to rule out the possibility of tumor development.
Summary
Neuropathic bladder with or without augmentation poses a fourfold to sixfold increase in bladder cancer risk compared with the general population.
Lethality of cancers seen in neurogenic bladder is worse than the general population, with 80 % demonstrating locally invasive (T2 or higher) and/or metastatic disease at the time of presentation.
Median survival from diagnosis is 1.5 years.
Risk of malignancy in augmentation cystoplasty:
Gastric cystoplasty 2.8 % per decade.
Colon or ileal cystoplasty 1.5 % per decade.
Renal transplantation with history of viral cystitis represents a very high risk group (sixfold to tenfold increase).
Despite elevated risk, routine cytology, FISH, and cystoscopy are not recommended, as sensitivity of determining malignancy is very poor and cost of these tests are high.
Recommended annual surveillance:
Interval medical history focused on determining whether baseline urological symptoms have changed.
Serum chemistries.
Radiographic screening (ultrasound, KUB, or CT when indicated).
Abnormalities seen on annual surveillance should prompt further diagnostic testing as appropriate
References
1.
2.
Husmann D, Spence H. Current status of tumor of the bowel following ureterosigmoidostomy: a review. J Urol. 1990;1440:607–11.
3.
Husmann D, Fox J, Higuchi T. Malignancy following bladder augmentation: recommendations for long-term follow-up and cancer screening. AUA Update Ser. 2011;30(24):222–7.
5.
6.
Husmann D. Malignancy after gastrointestinal augmentation. Ther Adv Urol. 2009;1:5–11.CrossRefPubMedCentralPubMed
7.
Filmer R, Spencer J. Malignancies in bladder augmentations and intestinal conduits. J Urol. 1990;143:671–5.PubMed
8.
9.
10.
Husmann D, Spence H. Ureterosigmoidostomy, current concepts. In: King L, Sonte A, Webster G, editors. Bladder reconstruction and continent urinary diversion. Chicago: Yearbook Medical Publishers; 1991. p. 213–20.
11.
12.
< div class='tao-gold-member'>
Only gold members can continue reading. Log In or Register to continue
Related posts:
Issues in the Long-Term Management of Adolescents and Adults with DSD: Management of Gonads, Genital Reconstruction, and Late Presentation of the Undiagnosed DSD
Posterior Urethral Valves in Adolescents: Clinical Problems, Management, and Follow-Up
Adult Survivors of Pediatric Genitourinary Tumors
Renal Transplantation in Patients with Lower Urinary Tract Dysfunction
Troubleshooting Continent Catheterizable Channels
The Transition Process: Initial Assessment and Development of a Treatment Plan
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
