Long-term complications arising from bowel interposition in the urinary tract

Abstract

After radical cystectomy or pathologies affecting the ureter(s), bowel segments can be employed to restore the natural urine flow or to create an external urinary diversion. Nevertheless, the interposition of bowel segments in the urinary tract is not devoid of complications. In fact, bowel's microstructure differs from the urothelium; specifically its mucosa is aimed at reabsorption, rather than storage. The aim of this paper is to revise the pathophysiology of complications related to bowel's mucosal properties. Those are: metabolic imbalance, malabsorption of vitamins, cholelitiasis, nephrolitiasis and infections. Their entity varies according to the segment used and to its length, which reflects the surface in contact with urine. Mostly, they occur on the long-term, but metabolic imbalances might occur soon after surgery as well.

The natural history of untreated muscle‐invasive bladder cancer

“…The fundamental understanding regarding the natural progression of MIBC is especially important in balancing the risks of cancer‐related morbidity and mortality vs treatment‐related morbidity and mortality in older patients. Indeed, RC is associated with non‐negligible morbidity, as well as mortality ; and radical treatment may affect patients’ urinary, bowel, sexual function, self‐image, and thus overall quality of life . While the risks of definitive local therapy, such as RC, have been described in detail and models have been developed for individual risk estimates and to facilitate patient counselling , the risks of leaving MIBC untreated have been markedly understudied.…”

“…Thus, medical comorbidities are not unlikely in this patient population and advanced age might pose the question of whether treatment should be recommended or not. In fact, RC with PLND is associated with non‐negligible rates of morbidity and mortality .…”

Considerations for the clinical use of stem cells in genitourinary regenerative medicine

“…For the long-segment reconstruction, the use of autologous bowel is the gold-standard[ 3 ]. However, this kind of tissue presents many potential complications, including metabolic imbalance, malabsorption of vitamins, cholelithiasis, nephrolithiasis and infections[ 21 ]. It is not unusual that multiple surgical procedures are needed over time due to stenosis or strictures at the repair site, which may require nephrectomy[ 3 ].…”

Experiences of wearing support garments by people living with a urostomy

“…A range of complications can occur after urostomy formation including specific urinary effects such as the risk of chronic urinary tract infections and deterioration in kidney function (hydronephrosis) (Martini et al, 2017) as well as more general ostomy related problems including stoma retraction, pouch leakage, sore skin and parastomal herniation (Wound, Ostomy and Continence Nurses society, 2014;Nazarko, 2014). A decrease in health-related quality of life (HRQOL) for 6 to 12 months after urostomy formation has been reported (Furukawa and Morioka, 2017).…”