[Cancer induction by urinary drainage or diversion through intestinal segments?]

Area of Science:

• Urology
• Oncology
• Gastroenterology

Context:

• Urinary diversion procedures using intestinal segments are associated with an increased risk of developing adenocarcinomas.
• The co-excretion of urine and feces can lead to endogenous nitrosamine synthesis, a potential carcinogen.
• Chronic irritation from urine and other urinary carcinogens may also contribute to tumor formation in diverted intestinal segments.

Purpose:

• To investigate the oncogenic potential of various intestinal urinary diversion techniques.
• To review reported tumor cases associated with different urinary diversion methods.
• To assess the risk of tumor induction in patients undergoing intestinal urinary diversion.

Summary:

• Ureterosigmoidostomy has been linked to 79 cases of sigmoid adenocarcinoma. Other intestinal diversions, including ileum conduits, colon conduits, and bladder augmentations, have also reported tumor development.
• While ureter substitution, Kock, and Camey techniques have not shown tumor induction, the overall data suggests intestinal urinary diversion can cause tumors.
• A latency period of at least 20 years between surgery and tumor diagnosis necessitates long-term surveillance for these patients.

Impact:

• Urinary diversion using intestine poses a significant long-term cancer risk, with expected morbidity increases post-1990.
• Regular radiological, endoscopic, and bioptic surveillance is essential for patients with intestinal urinary diversion.
• Oncological considerations should influence the choice of urinary diversion, especially in pediatric patients.