Is Heterotopic Bone Formation, Occurring Near a Cut Ureter, a Sign of Osteoinductive Potency of Human Urothelium?

Włodarski, K; Kuzaka, B; Włodarski, Paweł; Torz, Cezary

doi:10.1159/000282764

Cited by 4 publications

(1 citation statement)

References 13 publications

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“…suprapubic cystostomy, chronic urine leak, and then heterotopic bone formation in the pubic region, raises the possibility that risk factors related to the urinary system might be playing a role in heterotopic bone formation. Uncommon aetiological factors are: (1) an infected urinary tract serving as a source of antigenic material precipitating an immune response that triggers subsequent heterotopic ossification [5]; (2) inoculation of transitional epithelium into the soft tissues during suprapubic cystostomy, and subsequent heterotopic bone formation due to osteoinductive potential of human urothelium [6,7,8]; (3) chronic urine leak in the suprapubic region, which promoted heterotopic bone formation due to changes in local chemical and physical milieu [9].…”

Section: Discussionmentioning

confidence: 99%

Synostosis Between Pubic Bones due to Neurogenic, Heterotopic Ossification

Vaidyanathan

Hughes

Soni

2006

The Scientific World JOURNAL

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Neurogenic, heterotopic ossification is characterised by the formation of new, extraosseous (ectopic) bone in soft tissue in patients with neurological disorders. A 33-year-old female, who was born with spina bifida, paraplegia, and diastasis of symphysis pubis, had indwelling urethral catheter drainage and was using oxybutynin bladder instillations. She was prescribed diuretic for swelling of feet, which aggravated bypassing of catheter. Hence, suprapubic cystostomy was performed. Despite anticholinergic therapy, there was chronic urine leak around the suprapubic catheter and per urethra. Therefore, the urethra was mobilised and closed. After closure of the urethra, there was no urine leak from the urethra, but urine leak persisted around the suprapubic catheter. Cystogram confirmed the presence of a Foley balloon inside the bladder; there was no urinary fistula. The Foley balloon ruptured frequently, leading to extrusion of the Foley catheter. X-ray of abdomen showed heterotopic bone formation bridging the gap across diastasis of symphysis pubis. CT of pelvis revealed heterotopic bone lying in close proximity to the balloon of the Foley catheter; the sharp edge of heterotopic bone probably acted like a saw and led to frequent rupture of the balloon of the Foley catheter. Unique features of this case are: (1) temporal relationship of heterotopic bone formation to suprapubic cystostomy and chronic urine leak; (2) occurrence of heterotopic ossification in pubic region; (3) complications of heterotopic bone formation viz. frequent rupture of the balloon of the Foley catheter by the irregular margin of heterotopic bone and difficulty in insertion of suprapubic catheter because the heterotopic bone encroached on the suprapubic track; (4) synostosis between pubic bones as a result of heterotopic ossification..Common aetiological factors for neurogenic, heterotopic ossification, such as forceful manipulation, trauma, or spasticity, were absent in this patient. Since heterotopic bone formation was observed in the pubic region after suprapubic cystostomy and chronic urine leak, it is possible that risk factors related to the urinary tract might have played a role in heterotopic bone formation, which resulted in synostosis between pubic bones.

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Section: Discussionmentioning

confidence: 99%

Synostosis Between Pubic Bones due to Neurogenic, Heterotopic Ossification

Vaidyanathan

Hughes

Soni

2006

The Scientific World JOURNAL

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Der Harnleiterknochen

Meyer¹,

Kausch²,

Behm³

et al. 2006

Urologe

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Bone formation outside the skeleton is well known. Yet, ossification within the urogenital tract is rare. The case of a patient with distal ureteral obstruction, hydronephrosis, and subsequent circular osseous metaplasia of the ureter is presented. Open transperitoneal right-sided nephrectomy with partial resection of the ureter was performed. Intraoperatively and in histopathologic examination circular bone formation adjacent to the ureteral wall was detected. There was no evidence of malignancy. Early animal experiments in the twentieth century showed that bone metaplasia may be induced by epithelium of the urinary tract under certain conditions such as ischemia, inflammation, necrosis, sclerosis, and trauma. Osseous metaplasia may therefore be considered a differential diagnosis of calcification of the upper urinary tract in the absence of urolithiasis.

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