Re: Transition to adulthood with a bladder augmentation: histopathologic concerns

To the editor,

We read with interest the recent paper by Mammadov et al. examining the concerns regarding histological changes in adult neurogenic patients who have undergone bladder augmentation with bowel interposition as an adolescent or in childhood (¹).

The authors report a small study involving 20 patients who underwent selective anatomic bladder biopsies following augmentation for either neurogenic bladder, exstrophy or bladder neck trauma.

Two patients underwent open bladder biopsy as a simultaneous stone extraction procedure was planned. Neuropathic patients with a reconstructed or ablated urethra pose a challenge for the Urologist as they do not have dependant bladder drainage (²). Specific to the neurogenic patient with bladder calculi the authors should acknowledge that mitrofanoff cystolitholopaxy and concomitant bladder biopsy has been reported using a minimally invasive, hybrid technique thus avoiding the morbidity of open surgery (³).

Mammadov et al. reported no malignant histology in the study but did detect 2 cases of squamous metaplasia and 1 case of intestinal metaplasia (¹). One case of squamous metaplasia had a history of bladder stones similar to the case reported by Floyd Jr et al. (³).

In 2011, Higuchi at al examined 250 surveillance cystoscopies and although 4 lesions were identified, none were malignant leading the authors to conclude that annual surveillance cystoscopy was not cost effective (⁴). A separate publication by Higuchi at al also commented on immunosuppression as an independent risk factor for neoplastic development in bladder augmentation patients (⁵) and this has not been addressed by Mammadov et al.

The authors conclude by stating that surveillance cystoscopy in augmented patients less than 5 years post operatively is now limited to those with symptoms. This is a very pertinent clinical point. Hamid et al. detected no malignancy in a series of 92 augmented and substituted patients undergoing surveillance cystoscopy but detected higher rates of chronic inflammation in the augmented group (⁶). Furthermore, they concluded by stating that surveillance cystoscopy was not merited in patients less than 15 years post operatively but advised that investigations should be prompted by development of appropriate symptoms in these patients (⁶).

• Published as Ahead of Print: March 19, 2018

REFERENCES

• ¹
  Mammadov E, Dervisoglu S, Elicevik M, Emir H, Soylet Y, Buyukunal SNC. Transition to adulthood with a bladder augmentation: histopathologic concerns. Int Braz J Urol. 2017;43:1152-9.
• ²
  Franzoni DF, Decter RM. Percutaneous vesicolithotomy: an alternative to open bladder surgery in patients with an impassable or surgically ablated urethra. J Urol. 1999;162(3 Pt 1):777-8.
• ³
  Floyd MS Jr, Sakalis V, Davies MC. Mitrofanoff cystolitholopaxy and bladder biopsy using a mini-PCNL kit. J Clin Urol. 2017;10: 36-8.
• ⁴
  Higuchi TT, Fox JA, Husmann DA. Annual endoscopy and urine cytology for the surveillance of bladder tumors after enterocystoplasty for congenital bladder anomalies. J Urol. 2011;186:1791-5.
• ⁵
  Higuchi TT, Granberg CF, Fox JA, Husmann DA. Augmentation cystoplasty and risk of neoplasia: fact, fiction and controversy. J Urol. 2010;184:2492-6.
• ⁶
  Hamid R, Greenwell TJ, Nethercliffe JM, Freeman A, Venn SN, Woodhouse CR. Routine surveillance cystoscopy for patients with augmentation and substitution cystoplasty for benign urological conditions: is it necessary? BJU Int. 2009;104:392-5.

Publication Dates

• Publication in this collection
  Jul-Aug 2018

History

• Received
  15 Jan 2018
• Accepted
  22 Jan 2018