The defunctionalized bladder

Abstract

Supravesical urinary diversion without cystectomy is a common procedure performed to manage a variety of lower urinary tract pathologies. The purpose of this article is to review the complications associated with the bladder left in situ and to relate this to the female patient. Complications related to the defunctionalized bladder include pyocystis, hemorrhage, pain/spasm and neoplastic transformation. The defunctionalized bladder also has implications for sexual function, pregnancy and undiversion. The risk factors for complications are chronic infection, inadequate drainage, interstitial cystitis and previous irradiation. The incidence of neoplastic change in the defunctionalized bladder is low, but long-term follow-up is advised, as carcinoma could develop many decades after diversion. Sexual function following urinary diversion is better preserved when the bladder is retained.

Management of radiation cystitis

“…Alternative options for urinary diversion include percutaneous nephrostomy 39,40 and cutaneous ureterostomy. 41 Complications related to the defunctionalized bladder occur in more than 50% of patients who undergo urinary diversion, 42 and include pyocystis, hemorrhage, pain and neoplastic transformation; 43 therefore, cystectomy is recommended at the time of urinary diversion. 44 Preoperative high-dose radiation therapy contributes to increased postoperative morbidity rates, particularly enteroenteric fistulas, urointestinal fistulas and stenosis of the ureterointestinal anastomosis.…”

Unusual organism causing pyocystis in an immunosuppressed haemodialysis patient

“…Pyocystis is an often overlooked source of infection among anuric patients 3 4. More commonly it has been reported in patients with supravesical urinary diversion and a retained bladder with an incidence ranging from 10% to as high as 67% 3 5.…”

A forgotten complication of a defunctionalized urinary bladder: pyocystis

“…Pyocystis syndrome gained attention in the 1960s after urinary diversion procedures became the standard treatment for a variety of lower urinary tract pathologies. The reported incidence of this complication ranged from 10 % to as high as 67 % in patients with supravesical urinary diversion procedures [2,3]. It is reported to be rare in dialysis patients, but its actual incidence in that patient population is not known [3,4].…”

“…As part of wear and tear, the lining bladder epithelium is shed continuously, and then expelled out by urine flow. In anuric patients, the shed epithelial cells accumulate, and, when infected, pyocystis is typically ensued [1][2][3][4].…”

“…and Enterococcus spp. [2,3]. Diagnosis is based on symptoms of lower urinary tract infection, purulent discharge via the urethra or during catheterization, supported by CT scan imaging studies showing a characteristic thickened, hypertrophied, and cystic appearance of the bladder wall (Fig.…”