World Journal of Urology

, Volume 22, Issue 3, pp 178–185

Mucus production after transposition of intestinal segments into the urinary tract

Topic Paper


Following transposition into the urinary tract, intestinal segments continue to produce mucus and problems related to excessive production do not to diminish with time. Currently, 20 human mucin genes have been described and their protein products partially or fully characterised. As the use of transposed intestinal segments in urology increases, there is now a need for a better understanding of mucins at the gene and protein levels. There is also a need for urologists to be aware of the many complications related to excess mucus production. Whilst effective therapeutic measures to reduce mucus production and its related complications remain elusive, it is now clear that without such effective mucoregulatory agents the quality of life of patients will continue to be less than satisfactory. This review describes the biology of mucus and the problems related to continued production following transposition of intestinal segments into the urinary tract. Difficulties related to quantification of urinary mucus, in addition to the structural and mucin gene changes that occur in transposed segments, are addressed.


Mucus Mucin gene Urinary diversion Bladder reconstruction Neobladder 


  1. 1.
    Akerlund S, Berglund B, Kock NG, Philipson BM (1989) Voiding pattern, urinary volume, composition and bacterial contamination in patients with urinary-diversion via a continent ileal reservoir. Br J Urol 63:619–623PubMedGoogle Scholar
  2. 2.
    Allen A (1989) Gastrointestinal mucus. In: Forte JG (ed) Handbook of physiology—the gastrointestinal system, vol 3. American Physiological Society, Bethesda, pp 359–382Google Scholar
  3. 3.
    Allen A, Hoskins LC (1988) Colonic mucus in health and disease. In: Kirsner JB, Shorter RG (eds) Diseases of the rectum and colon. Williams and Wilkens, Baltimore, pp 65–94Google Scholar
  4. 4.
    Allen A, Hutton DA, Leonard AJ, Pearson JP, Sellers LA (1986) The role of mucus in the protection of the gastroduodenal mucosa. Scand J Gastroenterol 21:71–78Google Scholar
  5. 5.
    Allen A, Hutton DA, Pearson JP (1998) The muc2 gene product: a human intestinal mucin. Int J Biochem Cell B 30:797–801CrossRefGoogle Scholar
  6. 6.
    Anderson GG, Palermo JJ, Schilling JD, Roth R, Heuser J, Hultgren SJ (2003) Intracellular bacterial biofilm-like pods in urinary tract infections. Science 301:105–107CrossRefPubMedGoogle Scholar
  7. 7.
    Benderev TV (1988) Acetylcysteine for urinary tract mucolysis. J Urol 139:353–354Google Scholar
  8. 8.
    Bueler MR, Wiederkehr F, Vonderschmitt DJ (1995) Electrophoretic, chromatographic and immunological studies of human urinary proteins. Electrophoresis 16:124–134PubMedGoogle Scholar
  9. 9.
    Buisine M-P, Janin A, Maunoury V, Audie J-P, Delescaut M-P, Copin M-C, Colombel J-F, Degand P, Aubert J-P, Porchet N (1996) Aberrant expression of a human mucin gene (muc5ac) in rectosigmoid villous adenoma. Gastroenterology 110:84–91Google Scholar
  10. 10.
    Caponegro PJ, Leadbetter GWJr (1974) Acute ureteral obstruction secondary to mucoid impaction in supravesical diversion. Treatment with n-acetylcysteine. Urology 3:486–487Google Scholar
  11. 11.
    Chang SK, Dohrman AF, Basbaum CB, Ho SB, Tsuda T, Toribara NW, Gum JR, Kim YS (1994) Localization of mucin (muc2 and muc3) messenger-RNA and peptide expression in human normal intestine and colon-cancer. Gastroenterology 107:28–36Google Scholar
  12. 12.
    Chen Y, Zhao YH, Kalaslavadi TJ, Hamati E, Nehrke K, Le AD, Ann DK, Wu R (2004) Genome-wide search and identification of a novel gel-forming mucin muc19/muc19 in glandular tissues. Am J Resp Cell Mol 30:155–165CrossRefGoogle Scholar
  13. 13.
    Clamp JR, Creeth JM (1984) Some non-mucin components of mucus and their possible biological roles. Ciba Found Symp 109:121–136PubMedGoogle Scholar
  14. 14.
    Dekker J, Rossen JWA, Buller HA, Einerhand AWC (2002) The muc family: an obituary. Trends Biochem Sci 27:126–131CrossRefPubMedGoogle Scholar
  15. 15.
    Desseyn JL, Aubert JP, Porchet N, Laine A (2000) Evolution of the large secreted gel-forming mucins. Mol Biol Evol 17:1175–1184PubMedGoogle Scholar
  16. 16.
    Devaraj N, Sheykhnazari M, Warren WS, Bhavanandan VP (1994) Differential binding of Pseudomonas aeruginosa to normal and cystic fibrosis tracheobronchial mucins. Glycobiology 4:307–316PubMedGoogle Scholar
  17. 17.
    Forstner JF, Forstner GG (1994) Gastrointestinal mucus. In: Johnson LR (ed) Physiology of the gastrointestinal tract. Raven Press, New York, pp 1255–1283Google Scholar
  18. 18.
    George VK, Gee JM, Wortley MI, Stott M, Gaches CGC, Ashken MH (1992) The effect of ranitidine on urine mucus concentration in patients with enterocystoplasty. Br J Urol 70:30–32PubMedGoogle Scholar
  19. 19.
    Gillon G, Mundy AR (1989) The dissolution of urinary mucus after cystoplasty. Br J Urol 63:372–374PubMedGoogle Scholar
  20. 20.
    Godl K, Johansson MEV, Lidell ME, Morgelin M, Karlsson H, Olson FJ, Gum JRJ, Kim YS, Hansson GC (2002) The n terminus of the muc2 mucin forms trimers that are held together within a trypsin-resistant core fragment. J Biol Chem 277:47248–47256CrossRefPubMedGoogle Scholar
  21. 21.
    Haupt G, Pannek J, Knopf HJ, Schulze H, Senge T (1990) Rupture of ileal neobladder due to urethral obstruction by mucous plug. J Urol 144:740–741PubMedGoogle Scholar
  22. 22.
    Hendren WH, Hendren RB (1990) Bladder augmentation—experience with 129 children and young adults. J Urol 144:445–453Google Scholar
  23. 23.
    Ho SB, Roberton AM, Shekels LL, Lyftogt CT, Niehans GA, Toribara NW (1995) Expression cloning of gastric mucin complementary DNA and localization of mucin gene expression. Gastroenterology 109:735–747PubMedGoogle Scholar
  24. 24.
    Ho SB, Shekels LL, Toribara NW, Kim YS, Lyftogt C, Cherwitz DL, Niehans GA (1995) Mucin gene-expression in normal, preneoplastic, and neoplastic human gastric epithelium. Cancer Res 55:2681–2690PubMedGoogle Scholar
  25. 25.
    Hoskins LC (1981) Human enteric population ecology and degradation of gut mucins. Digest Dis Sci 26:769–772PubMedGoogle Scholar
  26. 26.
    Keegan SJ, Graham C, Neal DE, Blum-Oehler G, N’Dow J, Pearson JP, Gally DL (2003) Characterisation of Escherichia coli strains causing infections in patients with transposed intestinal segments. J Urol 169:2382–2387PubMedGoogle Scholar
  27. 27.
    Kent PW, Allen A (1968) The biosynthesis of intestinal mucins. The effect of salicylate on glycoprotein biosynthesis by sheep colonic and human gastric mucosal tissues in vitro. Biochem J 106:645–658PubMedGoogle Scholar
  28. 28.
    Kim YS, Gum J, Brockhausen I (1996) Mucin glycoproteins in neoplasia. Glyconjugate J 13:693–707Google Scholar
  29. 29.
    Lapensee L, Paquette Y, Bleau G (1997) Allelic polymorphism and chromosomal localization of the human oviductin gene (muc9). Fertil Steril 68:702–708CrossRefPubMedGoogle Scholar
  30. 30.
    Mantle M, Allen A (1978) A colorimetric assay for glycoproteins based on the periodic acid/Schiff stain. Biochem Soc Trans 6:607–609PubMedGoogle Scholar
  31. 31.
    Murray K, Nurse DE, Mundy AR (1987) Secretomotor function of intestinal segments used in lower urinary tract reconstruction. Br J Urol 60:532–535PubMedGoogle Scholar
  32. 32.
    N’Dow J, Pearson JP, Bennett MK, Neal DE, Robson CN (2000) Mucin gene expression in human urothelium and in intestinal segments transposed into the urinary tract. J Urol 164:1398–1404PubMedGoogle Scholar
  33. 33.
    N’Dow J, Robson CN, Matthews JN, Neal DE, Pearson JP (2001) Reducing mucus production after urinary reconstruction: a prospective randomized trial. J Urol 165:1433–1440PubMedGoogle Scholar
  34. 34.
    Pearson JP, Brownlee IA, Taylor C (2004) Mucin genes in the gi tract. In: Williams PA, Phillips GO (eds) Gums and stabilisers for the food industry, vol 12. Royal Society of Chemistry, Cambridge, (in press)Google Scholar
  35. 35.
    Quigley EMM, Turnberg LA (1987) Ph of the microclimate lining human gastric and duodenal mucosa in vivo—studies in control subjects and in duodenal ulcer patients. Gastroenterology 92:1876–1884PubMedGoogle Scholar
  36. 36.
    Rhodes M, Allen A, Dowling RH, Murphy G, Lennard TWJ (1992) Inhibition of human gall-bladder mucus synthesis in patients undergoing cholecystectomy. Gut 33:1113–1117PubMedGoogle Scholar
  37. 37.
    Rhodes M, Allen A, Lennard TWJ (1992) Mucus glycoprotein-biosynthesis in the human gall bladder—inhibition by aspirin. Gut 33:1109–1112PubMedGoogle Scholar
  38. 38.
    Roberton AM, Rabel B, Stubbs L, Tasmanjones C, Lee SP (1996) Aspirin changes the secretion rate and amino acid composition of human small intestinal mucin in subjects with ileal conduits. Glycoconjugate J 13:781–789Google Scholar
  39. 39.
    Sarosiek J, Mizuta K, Slomiany A, Slomiany BL (1986) Effect of acetylsalicylic acid on gastric mucin viscosity, permeability to hydrogen ion, and susceptibility to pepsin. Biochem Pharmacol 35:4291–4295CrossRefPubMedGoogle Scholar
  40. 40.
    Scharfman A, Lamblin G, Roussel P (1995) Interactions between human respiratory mucins and pathogens. Biochem Soc Trans 23:836–839PubMedGoogle Scholar
  41. 41.
    Schroten H, Hanisch FG, Plogmann R, Hacker J, Uhlenbruck G, Nobisbosch R, Wahn V (1992) Inhibition of adhesion of s-fimbriated Escherichia coli to buccal epithelial cells by human milk fat globule membrane components—a novel aspect of the protective function of mucins in the nonimmunoglobulin fraction. Infect Immun 60:2893–2899PubMedGoogle Scholar
  42. 42.
    Seifter S, Dayton S, Novic B, Muntwyler E (1950) The estimation of glycogen with the anthrone reagent. Arch Biochem Biophys 25:191–200Google Scholar
  43. 43.
    Shankar V, Gilmore MS, Elkins RC, Sachdev GP (1994) A novel human airway mucin cDNA encodes a protein with unique tandem-repeat organization. Biochem J 300:295–298PubMedGoogle Scholar
  44. 44.
    Smirnova MG, Guo L, Birchall JP, Pearson JP (2003) Lps up-regulates mucin and cytokine mRNA expression and stimulates mucin and cytokine secretion in goblet cells. Cell Immunol 221:42–49CrossRefPubMedGoogle Scholar
  45. 45.
    Strugala V, Allen A, Dettmar PW, Pearson JP (2003) Colonic mucin: methods of measuring mucus thickness. Proc Nutr Soc 62:237–243CrossRefPubMedGoogle Scholar
  46. 46.
    Taylor C, Allen A, Dettmar PW, Pearson JP (2003) The gel matrix of gastric mucus is maintained by a complex interplay of transient and nontransient associations. Biomacromolecules 4:922–927CrossRefPubMedGoogle Scholar
  47. 47.
    Weimer HE, Moshin JR (1953) Serum glycoprotein concentrations in experimental tuberculosis of guinea pigs. Am Rev Tubercul Pulmonol 68:594–602Google Scholar
  48. 48.
    Williams SJ, Wreschner DH, Tran M, Eyre HJ, Sutherland GR, McGuckin MA (2001) Muc13, a novel human cell surface mucin expressed by epithelial and hemopoietic cells. J Biol Chem 276:18327–18336CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Academic Urology UnitUniversity of Aberdeen
  2. 2.Department of Physiological SciencesThe Medical School
  3. 3.Department of SurgeryAddenbrooke’s Hospital
  4. 4.Department of SurgeryThe Medical SchoolAberdeenScotlandUK

Personalised recommendations