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Pathologic features of the ureteroileal anastomosis in ileal conduits in childhood
R W Byard1, G E Phillips, S Ahmed
1Department of Histopathology, Adelaide Children's Hospital, South Australia.
Insights
Ileal conduit urinary diversions can cause late complications like hydroureteronephrosis. Histologic analysis revealed changes such as cysts and polyps at the ureteroileal anastomosis, potentially causing obstruction.
Area of Science:
- Urology
- Surgical Pathology
- Gastroenterology
Background:
- Ileal conduit urinary diversions frequently lead to late complications requiring revision surgery.
- The exact causes of these complications, including hydroureteronephrosis and conduit strictures, are not fully understood.
Purpose of the Study:
- To investigate the histologic features of ureteroileal anastomoses in patients with ileal conduit urinary diversions.
- To identify potential causes of late complications and ureteroileal obstruction.
Main Methods:
- Histologic review of 20 ureteroileal anastomoses from 12 patients.
- Detailed examination for chronic changes, epithelial alterations, mucus pooling, and cyst/polyp formation.
Main Results:
- Variable chronic changes were observed in all anastomoses.
- Histologic findings included dilated intestinal glands, transitional epithelial-lined cysts, mucus pools, and polypoid lesions.
- Larger cysts (over 1-2 mm) and polyps were noted, potentially contributing to ureteroileal obstruction.
Conclusions:
- Histologic changes like cyst and polyp formation at the ureteroileal anastomosis may contribute to obstruction.
- These findings have implications for understanding complications in bowel segment urinary tract reconstructions.
Abstract:
Ileal conduit urinary diversions are associated with a high incidence of late complications often requiring major revision surgery. Although the etiology of the late complications is not always clear, there may be unilateral or bilateral hydroureteronephrosis, with the conduits showing narrowing and stricture formation with villous atrophy, chronic inflammation, and fibrosis. Histologic review of 20 ureteroileal anastomoses from 12 patients showed variable degrees of chronic changes. In addition, cystically dilated intestinal glands were noted in six anastomoses, transitional epithelial-lined cysts were noted in nine, aggregated pools of mucus were noted in four, mixed transitional and intestinal epithelial-lined cysts were noted in two, and polypoid lesions with mucus pools or cysts projecting into the lumen were noted in five. Twelve cysts measured over 1 mm in diameter; six measured over 2 mm. These histologic features may result from overgrowth of intestinal glands by transitional epithelium, with subsequent gland dilatation, rupture, and mucus pooling. It is possible that the larger "cysts" and "polyps" may have contributed to the ureteroileal obstruction, a finding that may have bearing on other types of urinary tract reconstructions using bowel segments.