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Published on: January 7, 2019
[Management of urinary complication in Crohn's disease]
Genichi Ishii1, Norie Tanaka, Hiroshi Hara
1Department of Urology, Toho University School of Medicine, Japan.
Insights
Urinary complications in Crohn's disease (CD) are uncommon but challenging. Standardized treatment for urolithiasis in CD patients is recommended, while surgical intervention post-medical therapy is advised for urinary fistulas.
Area of Science:
- Gastroenterology
- Urology
- Surgical Oncology
Context:
- Crohn's disease (CD) can lead to rare but complex urinary tract complications.
- There is a lack of established treatment guidelines for these complications.
- This study retrospectively analyzes urinary issues in CD patients.
Purpose:
- To determine the frequency of urinary complications in Crohn's disease patients.
- To discuss diagnostic and therapeutic strategies for these complications.
- To evaluate treatment outcomes for urolithiasis and urinary fistulas in CD.
Summary:
- Urinary complications occurred in 4.8% of 1,551 Crohn's disease patients.
- Urolithiasis (4.0%) was most common, followed by urinary fistula (0.9%) and urachal abscess (0.06%).
- Treatment for urolithiasis was successful with medical or surgical approaches; urinary fistulas and abscesses required surgical intervention.
Impact:
- Standardized treatment for urolithiasis in CD patients is suggested.
- Preoperative medical therapy followed by surgery is recommended for urinary fistulas in CD to improve quality of life and potentially avoid intestinal resection.
Purpose:
Although urinary complications of Crohn's disease are relatively rare, they often present diagnostic and therapeutic dilemmas. However, there is no established strategy for treating urinary complications of Crohn's disease. In the present clinical study, we describe the frequency of urinary complications of Crohn's disease, and discuss various approaches to their diagnosis and treatment.
Patients And Methods:
The subjects were 1,551 patients who underwent medical treatment for Crohn's disease between January 1994 and May 2002 at Social Insurance Central General Hospital. The subjects were retrospectively evaluated.
Results:
Urinary complications occuered in 75 of the 1,551 patients (4.8%): urolitiasis in 60 patients, urinary fistula in 14 patients, and urachal abscess (Enterourachocutaneous fitulas) in 1 patient. A total of 41 of the 75 patients with urinary complications (55%) consulted a practicing urologist: 26 patients with urolithiasis, 14 patients with urinary fistula and 1 patient with urachal abscess. 26 patients with urolithiasis received medical treatment: 20 patients underwent conservative therapy, 4 patients underwent ESWL, and 2 patients underwent TUL. In all 26 of those cases, the treatment was successful. Twelve of the 14 patients with urinary fistulas (86%) underwent resection of the inflamed intestine combined with reconstruction of the urinary tract. The 1 patient with urachal abscess underwent resection of the urachus and the inflamed intestine, and partial cystectomy.
Conclusion:
All patients with urolithiasis should be treated the same way, whether or not they have Crohn's disease. In patients with Crohn's disease complicated by urinary fistula, surgery should be performed after preoperative medical therapy, as it improves the quality of life of such patients more rapidly than other approaches and may help avoid intestinal resection.
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