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Persistent histological changes in the exstrophic bladder after primary closure - a cause for concern?
MedLine Citation:
PMID:  22986039     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: To investigate bladder biopsies from patients with classical bladder exstrophy (BE) for their histological features and discuss the potential clinical significance of the findings. DESIGN AND METHODS: From 2004 to 2011 bladder tissues were collected from patients with BE. These were obtained at the time of primary bladder closure (group I, n=29), during secondary reconstructive procedures (group II, n=27) or during cystectomy for failed reconstruction (group III, n=15). All tissues specimens were investigated for inflammatory, proliferative, meta- and dysplastic changes. Expression of urothelial differentiation markers CK13 and CK20 was determined by immunohistochemistry. RESULTS: Inflammatory, proliferative and metaplastic changes were found in bladder specimens of all subgroups. Neither dysplasia nor neoplasia was present. Severe epithelial changes such as cystitis glandularis and intestinal metaplasia were observed in up to 62% of bladders several years after primary closure. Aberrant expression patterns of CK13 and CK20 suggesting abnormal urothelial differentiation were shown to be present in the urothelium of all subgroups. CONCLUSION: Our findings provide prima facie evidence that the epithelial changes observed in the unclosed bladder template persist or even progress in a subset of bladders after primary closure. Although the malignant potential of cystitis glandularis and intestinal metaplasia is controversial, some bladders may be at increased risk of developing dys-/neoplasia in the long term. As the natural history of these lesions in the exstrophic bladder is unknown, patients require lifelong surveillance.
Authors:
Peter C Rubenwolf; Fabian Eder; Anne-Karoline Ebert; Ferdinand Hofstaedter; Christopher R J Woodhouse; Wolfgang H Roesch
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-14
Journal Detail:
Title:  The Journal of urology     Volume:  -     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Pediatric Urology, University Medical Center Regensburg, Germany. Electronic address: peter.rubenwolf@unimedizin-mainz.de.
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