Urological Research

, Volume 23, Issue 6, pp 365–370 | Cite as

Tumor induction and prophylaxis following different forms of intestinal urinary diversion in a rat model

  • T. Kälble
  • K. Busse
  • F. Amelung
  • R. Waldherr
  • M. R. Berger
  • L. Edler
  • H. Riedmiller
Original Paper

Abstract

Eighty Wistar rats were randomized into two groups. In group 1 vesicosigmoidostomy with proximal colostomy was performed, in group 2, vesicosigmoidostomy. The total tumor incidence did not differ significantly (group 1 10/40, 25%; group 2 13/40, 32.5%). The tumor spectrum differed, with more adenocarcinomas in group 2 (11/40, 27.5% vs 4/40, 10%;P=0.047) and urothelial carcinomas only in group 1 (5/40, 2.5%). One hundred and ten other Wistar rats were randomized into three groups. Animals in group A received vesicoileosigmoidostomy, group B, two-step vesicosigmoidostomy with initial separation of urine and the urocolonic anastomosis, group C, vesicosigmoidostomy. Significantly fewer adenocarcinomas were observed in group A (2/40, 5%) than in group B (16/40, 40%,P<0.002) and group C (9/30, 30%;P<0.007). These results indicate a similar cancer risk in all continent forms of urinary diversion, at least via colon. Ileal interposition seems to be an effective carcinoma prophylaxis following ureterosigmoidostomy. The proliferative instability at the urointestinal anastomosis is crucial for the pathogenesis and prophylaxis of this form of carcinogenesis, whereas urine seems to play only a minor role.

Key words

Urinary diversion Carcinoma induction Carcinoma prophylaxis Ileal interposition Urointestinal anastomosis 

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References

  1. 1.
    Badiola F, Manivel CJ, Gonzalez R (1991) Seromuscular enterocystoplasty in rats. J. Urol 146:559Google Scholar
  2. 2.
    Crissey MM, Steele GD, Gittes RF (1980) Rat model for carcinogenesis in ureterosigmoidostomy. Science 207:1079Google Scholar
  3. 3.
    Daher N, Gautier R, Abourachid H, Decaens C, Bara J (1988) Rat colonic carcinogenesis after ureterosigmoidostomy: pathogenesis and immunohistological study. J Urol 139:1331Google Scholar
  4. 4.
    Gennaro AR, Villanueva R, Sukonthaman Y, Vathanophas V, Rosemond GP (1973) Chemical carcinogenesis in transposed intestinal segments. Cancer Res 33:536Google Scholar
  5. 5.
    Gittes RF (1986) Carcinogenesis in ureterosigmoidostomy. Urol Clin North Am 13:201Google Scholar
  6. 6.
    Gregoire M, Kantoff P, DeWolf CW (1993) Synchronous adenocarcinoma and transitional cell carcinoma of the bladder associated with augmentation: case report and review of the literature. J Urol 149:115Google Scholar
  7. 7.
    Kälble T (1993) The risk of malignancy after cystoplasty. Cur Opin Urol 3:476Google Scholar
  8. 8.
    Kälble T, Tricker AR, Berger M, Amelung R, Waldherr R, Hothorn L, Möhring K, Staehler G (1991) Tumor induction in a rat model for ureterosigmoidostomy without evidence of nitrosamine formation. J Urol 146:862Google Scholar
  9. 9.
    Kälble T, Schreiber W, Berger MR, Waldherr R, Amelung F, Möhring K, Staehler G (1993) Risk of carcinoma in different forms of urinary diversion via intestine. Aktnelle Urol 24:1Google Scholar
  10. 10.
    Kim KS, Susskind MR, King LR (1988) Ileocecal ureterosigmoidostomy: an alternative to conventional ureterosigmoidostomy. J Urol 140:1494Google Scholar
  11. 11.
    Kingsnorth AN, King WK, Diekema KA, McCann PP, Ross JS, Malt RA (1983) Inhibition of ornithine decarboxylase with 2-difluoromethylornithine: reduced incidence of dimethylhydrazine-induced colon tumors in mice. Cancer Res 43:2545Google Scholar
  12. 12.
    Kliment J, Luptak J, Lofaj M, Horakova M, Beseda A (1993) Carcinoma of the colon after ureterosigmoidostomy and trigonosigmoidostomy for exstrophy of the bladder. Int Urol Nephrol 25:339Google Scholar
  13. 13.
    Kock GN, Mohamed AG, Lycke GK, Mahran RM (1988) Urinary diversion to the augmented and valved rectum: preliminary results with a novel surgical procedure. J Urol 140:1375Google Scholar
  14. 14.
    Marino BM, Vitale L, Kiss A, Rossi R, Drago GW (1994) Carcinoma of the large intestine following ureterosigmoidostomy in a patient with bladder exstrophy. Minerva Chir 49Google Scholar
  15. 15.
    Miersch WDE, Vogel J (1992) Induction of carcinoma at ureterosigmoid anastomosis—with and without faecal stream. Br J Urol 69:499Google Scholar
  16. 16.
    Rappolee AD, Mark D, Banda MJ, Werb Z (1988) Wound macrophages express TGF-alpha and other growth factors in vivo: analysis by mRNA phenotyping. Science 242:708Google Scholar
  17. 17.
    Reddy SB, Tokumo K, Kulkarni N, Aligia C, Kelloff G (1992) Inhibition of colon carcinogenesis by prostaglandin synthesis inhibitors and related compounds. Carcinogenesis 13:1019Google Scholar
  18. 18.
    Roe R, Fermor B, Williamson RCN (1987) Proliferative instability and experimental carcinogenesis at colonic anastomoses. Gat 28:808Google Scholar
  19. 19.
    Schuh AC, Keating J, Monteclaro FS, Vogt PK, Breitman ML (1990) Obligatory wounding requirement for tumorigenesis in v-jun transgenic mice. Nature 346:756Google Scholar
  20. 20.
    Spencer JR, Steckel J, May M, Marion D, Hernandez K, Vaughan ED Jr (1993) Histological and bacteriological findings in long-term ileocystoplasty and colocystoplasty in the rat. J Urol 150:1321Google Scholar
  21. 21.
    Strachan JR, Matthews J, Rees HC, Cooke T (1987) Kinetic changes in experimental colonic urinary diversion. Br J Surg 74:1046Google Scholar
  22. 22.
    Thun MJ, Mohan MD, Namboodiri M, Heath C Jr (1991) Aspirin use and reduced risk of fatal colon cancer. N Engl J Med 325:1593Google Scholar
  23. 23.
    Weber TR, Westfall SH, Steinhardt GF, Webb L, Avila CS, Conners RH (1988) Malignancy associated with ureterosigmoidostomy: detection by mucosa ornithine decarboxylase. J. Pediatr Surg 23:1091Google Scholar
  24. 24.
    Williamson RCN, Davies PW, Bristol JB, Wells M (1992) Intestinal adaptation and experimental carcinogenesis after partial colectomy. Gut 23:316Google Scholar
  25. 25.
    Young PR, Kreder KJ, Akwari O, Godfried M, Webster GD, Durham NC (1993) Carcinogenic potential in augmented bladders: a rat model. J. Urol 149:373AGoogle Scholar
  26. 26.
    Yura Y, Hayashi O, Kelly M, Oyasu R (1989) Identification of epidermal growth factor as a compenent of the rat urinary bladder tumor-enhancing urinary fractions. Cancer Res 49:1548Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • T. Kälble
    • 1
  • K. Busse
    • 1
  • F. Amelung
    • 2
  • R. Waldherr
    • 3
  • M. R. Berger
    • 2
  • L. Edler
    • 4
  • H. Riedmiller
    • 1
  1. 1.Klinik für UrologieUniversität MarburgMarburgGermany
  2. 2.Institute of Experimental PathologyGerman Cancer Research CenterHeidelbergGermany
  3. 3.Institute of PathologyUniversity of HeidelbergHeidelbergGermany
  4. 4.Institute of BiostatisticsGerman Cancer Research CenterHeidelbergGermany

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