Abstract
A 22-year review of 328 patients with Crohn's disease revealed 70 patients with urinary tract symptoms. Cystitis was the most common problem, occurring in 44 patients. The urinary tract infections were recurrent in most patients, usually with 3 or 4 attacks per year. Despite the persistence of urinary infection, only 3 patients developed chronic pyelonephritis. Forty-nine patients had intravenous urography, and many were found to have slight dilatation of the upper urinary tract on one side. Seven patients had hydronephrosis, 3 with pyonephrosis. Five of 6 patients who developed calculi had a bowel resection. All of the recovered calculi were oxalate stones, but 3 were passed spontaneously and not analyzed. Eight patients, 7 of them males, had an ileovesical fistula. In 1, the colon was also affected. It was unusual for these patients to have severe urinary symptoms. One patient had a fistula from the rectum to the urethra. Although 32 of the 70 patients were female, most of the severe complications occurred in men. Aggressive investigation is not indicated, nor is radical surgery required.
Résumé
Sur 328 cas de maladie de Crohn traités en 22 ans, 70 présentaient des symptomes urinaires. Le problème le plus fréquent est la cystite: 44 cas. Les infections urinaires sont le plus souvent récidivantes, avec 3–4 poussées par an. Malgré cette infection persistante, 3 malades seulement ont développé une pyélonéphrite chronique. Une urographie intraveineuse, faite chez 49 patients, a montré fréquemment une dilatation unilatérale modérées des cavités urinaires hautes. Sept malades avaient une hydronéphrose, dont 3 avec pyonéphrose. Six malades ont fait une lithiase rénale: 5 avaient subi une résection intestinale. Tous les calculs analysés étaient des calculs d'oxalate (3 calculs éliminés spontanément n'ont pas été examinés). Huit malades, dont 7 hommes, ont présenté une fistule iléovésicale; dans 1 cas, le colon était également atteint; ces malades ne présentent que rarement des symptomes urinaires graves; 1 patient avait une fistule entre le rectum et l'urètre. Sur les 70 patients, 32 étaient des femmes. Mais la majorité des complications graves surviennent chez l'homme. Les investigations aggressives et la chirurgie radicale sont contre-indiquées.
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Kyle, J. Urinary complications of Crohn's disease. World J. Surg. 4, 153–159 (1980). https://doi.org/10.1007/BF02393564
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DOI: https://doi.org/10.1007/BF02393564