Home   Chapter Home   Jobs   Conferences   Fellowships   Books



Advertisement

Bladder

Acquired non-neoplastic anomalies

Urinary diversion / neobladder


Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center - Fairview (see Reviewers page)
Revised: 5 July 2011, last major update June 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
=========================================================================

● Portions of ileum or colon used in adults and children to treat congenital anomalies, dysfunctional bladder or post-cystectomy for malignancy
● Options are to enlarge capacity of bladder (augmentation), channel urine into temporary artificial reservoir while a new bladder is being created or create a neobladder (new bladder after cystectomy)

Terminology
=========================================================================

Patients who must have their bladder removed usually have three options for urine elimination:
1. Ileal Conduit (Urostomy) – Conduit of small intestine or colon carries the urine to an opening on the abdomen
2. Orthotopic neobladder – Neobladder made from loops of intestine to store the urine and individual can void through normal channels
3. Continent urinary diversion – Creation of an internal pouch from loops of intestine which is connected to an opening on the abdomen through a “one way” passage

Clinical features
=========================================================================

● Ileal neobladder produces good functional results (J Urol 1999;161:422)

Complications:
● Intestinal adenocarcinoma in colonic conduits, reflux but only rare renal failure in ileal conduits, highest risk of adenocarcinoma is in augmentation cystoplasty (J Urol 1997;157:482)
● Frequent complications but low reoperation rate in conduit urinary diversion (J Urol 2011;185:562)
● Monitor for carcinoma with cytology (direct smears after centrifugation)
● Note: must also monitor nonfunctionalized bladder, if present (J Urol 2006;176:620)

Case reports
=========================================================================

● 39 year old male with tubular adenoma in ileal segment 34 years after augmentation ileocystoplasty (Diagn Pathol 2007 Aug 13;2:29)
● 67 year old man with adenocarcinoma 20 years after ileal neobladder (Urology 2006;68:1343)

Clinical images
=========================================================================



Continent urinary diversion using ileum

Micro description
=========================================================================

● Inflamed, atrophic and partially denuded epithelium
Candida in ileal conduits

Micro images
=========================================================================



Tubular adenoma with high grade dysplasia after augmentation ileocystoplasty

Differential diagnosis
=========================================================================

Normal intestinal cells: aggregates are normally present in urinary diversion specimens, may resemble malignancy

Additional references
=========================================================================

eMedicine

End of Bladder > Acquired non-neoplastic anomalies > Urinary diversion / neobladder


This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).