Tumor growth in urinary diversion: a multicenter analysis.

摘要

BACKGROUND: The risk estimation of secondary tumors after different types of urinary diversion with intestinal segments is possible only for ureterosigmoidostomy owing to the lack of follow-up studies of other forms of urinary diversions. OBJECTIVE: We calculated the prevalence of secondary tumors associated with different forms of urinary diversion, relating the number of reported tumors to the number of performed diversions in German clinics. DESIGN, SETTING, AND PARTICIPANTS: We analyzed the operative records of 44 German clinics for urinary diversions performed from 1970 to 2007 and registered all reported secondary tumors up to 2009. MEASUREMENTS: For statistical comparison of the different tumor prevalences, Fisher exact test was used. Additionally, we compared tumor locations and latency periods in different forms of urinary diversions. RESULTS AND LIMITATIONS: In 17,758 urinary diversions, 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (2.58%) and cystoplasty (1.58%) was significantly higher than in other continent forms of urinary diversion (p<0.0001). The risk in orthotopic (ileo-)colonic neobladders (1.29%) was significantly higher (p=0.0001) than in ileal neobladders (0.05%). The difference between ileocecal pouches (0.14%) and ileal neobladders was not significant (p=0.46), and the tumor risk with ileal conduits was minimal (0.02%). CONCLUSIONS: Ureterosigmoidostomies, cystoplasties, and probably orthotopic (ileo-)colonic neobladders bear a significantly increased tumor risk compared with the general population and necessitate regular endoscopic evaluation from at least the fifth postoperative year. Regular endoscopy is not imperative after ileal neobladders and conduits, but with catheterizable ileocecal pouches, it is recommended in the presence of symptoms such as hydronephrosis, chronic urinary infection, and hematuria.