Long-Term Malignancy Risk on Enteric Bladder Augmentations: Role of Microsatellite Cytogenetic Analysis

Abstract

Purpose Patients who have undergone intestinal augmentation cystoplasty could be at risk for developing latent bladder malignancy, as urothelian neoplasm and adenocarcinoma. No consensus exists on the follow-up for these patients. Our endpoint was to define the long-term follow-up and testing the sensibility and specify of a new non-invasive genetic method based on microsatellite analysis. Material and Methods Consecutive non-selected patients who underwent augmentation cystoplasty from 1998 to 2005 were enrolled. Renal/bladder ultrasound, urine cystology, cystoscopy and multiple bladder biopsies with microsatellite analysis for loss of heterozygosity in urine, blood and tissue samples were performed. Biopsies were taken form the native bladder, augmented segment and anastomotic line. Results On a total of 103 patients, 96 were enrolled and 20 completed the study (till now): 8 ileo-cystoplasty, 5 sigmoido-cystoplasty, 4 uretero-cystoplasty and 3 gastrocystoplasty. No bladder malignancy was found. Abnormal histology was present in 16 patients (80%): 14 chronic inflammation (7 ileo-cystoplasty, 4 sigmoido-cystoplasty, 3 gastrocystoplasty), 1 nephrogenic adenoma (ileo-cystoplasty), 1 dysplasic (sigmoido-cystoplasty). No pathological changes were observed in the ureterocystoplastics. No loss of heterozigosity was found in urine, blood and tissue samples at microsatellite analysis. Conclusions Malignancy prevalence has been estimated up to 2% after 10 or more years form enterocystoplasty. No malignancy changes but 16 (80%) carcinogenic lesions have been found in our initial series We advocate a policy of annual (biannual if dysplastic lesions) bladder biopsies as part of long-term screening. Cytogenetic microsatellite analysis showed no loss of heterozygosity in our 20 cases, but further studies will hopefully define the benefits and role of cancer surveillance by non-invasive techiniques.