Tubular Adenoma in the Indiana Pouch of a Patient With a History of Bladder Exstrophy

Abstract

An increased risk of neoplasm has been noted when bowel segments are used for urinary diversion. Particularly true for ureterosigmoidostomy, colonic adenocarcinoma has rarely been reported following Indiana Pouch diversion. This report describes a 42-year-old woman with a history of bladder exstrophy who developed a polyp in her Indiana Pouch 24 years after its creation. The polyp, found incidentally, was a tubular adenoma with high-grade dysplasia. Due to its malignant potential, the polyp was resected with preservation of the Indiana Pouch. This case highlights the need for lifetime surveillance in urinary reservoir patients who received diversions at a young age.

Step by step Indiana pouch construction in a previously irradiated patient with a cervical cancer relapse

“…It occurs in approximately 10% of the patients following ureterosigmoidostomy, however Bell et al describe a case of adenocarcinoma in Indiana pouch constructed 8 years prior to the diagnosis [17]. There is a suggested surveillance protocol using cystoscopy screening starting 10 years after the creation of the urinary diversion [18], which we will also consider adopting once we reach the 5 year follow-up instead of waiting for 10 years, having evidence that there are some occurring cases before that time span.…”

Management of advanced adenocarcinoma in Indiana Pouch urinary diversion

“… 3 Proposed surveillance protocols include cystoscopy screening with regular intervals starting 10 years after diversion. 1 Here we present a rare case of an 80-year-old woman with a history of bladder cancer who developed adenocarcinoma in her Indiana pouch 8 years after its creation. The tumor was found to have high microsatellite instability (MSI-H), which could be familial but can be sporadic in 10–15% of patient with the incidence increasing with age.…”

“…The dominant theory of pathogenesis is understood as the generation of the carcinogen nitrosamine due to exposure of urine. 1 This pathogenesis occurs most frequently following ureterosigmoidostomy with more than 10% of patients developing neoplasia following this form of urinary diversion. 2 The Indiana pouch is comprised of approximately 30 cm of the proximal right colon for pouch formation in continuity with 10 cm of the terminal ileum for the catheterizable channel and utilizes the ileal cecal valve for continence.…”