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Bacterial growth in urine collected in ileal loop receptacles
LETTERS TO THE EDITOR
BACTERIAL GROWTH IN URINE COLLECTED IN ILEAL LOOP RECEPTACLES The suppression of bacterial growth and ammonia formation in receptacles for urinary diversions described by K. Gerhard Brand, M.D., James R. Boen, Ph.D., and John F. Van Pilsum, Ph.D., in their article, “Suppression of Bacterial Growth and Ammonia Formation by Citrate Buffer in Urine Collected in Ileal Loop Receptacle,” published in the December issue (vol. 6, page 738) of UROLOGY, has definite potential advantages for patients. As they suggest, retarding the growth of bacteria in urine collection devices will apparently inhibit odor and reduce peristomal skin irritation. Further, this procedure may diminish the incidence of ascending urinary tract infections, formation of mucus (which plugs outlet valves) and crystallization of calcium on the appliance (which leads to stoma1 bleeding). However, eliminating the particularly offensive urease-producing bacteria that proliferate in alkaline urine can be accomplished by less complex methods of acidification than the citrate buffer used by these authors. Oral intake of ascorbic acid is an inexpensive and extremely easy means of achieving similar ends. Ingestion of vitamin C at doses in excess of 2 Gm. per day will maintain acidic pH or urine in most adults. This practice would eliminate the need for persons with urinary diversions to obtain the sodium citrate, mix and preserve the solution, and instill it into their appliance after each emptying. Although little is known about the metabolism of vitamin C or its potential for toxicity, there appear to be few contraindications to ingestion in excessive doses. Persons who have a high capacity to convert ascorbic acid to oxalate are rare but may be at risk for renal calcification if given high doses of vitamin C.* To the Editor:
Robin R. Young, R.N., M.S. Stoma Program Boston University School of Nursing Boston, Massachusetts 02215 *Briggs, M. H., Garcia-Webb,
P., and Davies, P.:
Urinary oxalate and vitamin C supplements, Lancet 2: 201 (1973).
PELVIC
LIPOMATOSIS
When commenting on their 3 cases of pelvic lipomatosis (UROLOGY, vol. 7, page 108), Stephen Radinsky, D.O., Editor Cabal, M.D., and
To the Editor:
566
John Shields, M.D., apparently failed to review the urologic literature. Perhaps as a result, several statements were made which I believe are in error. 1. Pelvic lipomatosis is frequently related to obesity. This relationship was first noted by Fogg and Smyth.’ Successful dietary treatment of pelvic lipomatosis was recently reported by Sacks and Drenick. 2 2. Surgical excision of the fatty tissue is possible and was first accomplished by Dr. Wyland Leadbetter. That patient, reported by me in 1973,3 continues to be well, and his hydronephrosis has subsided. 3. Renal function frequently deteriorates, particularly in younger people with this disease. Careful follow up of patients is necessary, and in addition, many of the patients have associated cystitis glandularis which theoretically has malignant potential.4 Perhaps a moritorium on further case reports is indicated until there have been significant advances in understanding the pathophysiology and treatment of this interesting disease. A. Alden Carpenter, M.D. 62 Columbian Street South Weymouth, Massachusetts 02199 References
FOGG, L. B., and SMYTH, J. W.:
Pelvic lipomatosis: a condition simulating pelvic neoplasm, Radiology 90: 558 (1968). SACKS,S.A., and DRENICK,E. J.: Pelvic lipomatosis: effect of diet, Urology 6: 609 (1975). CARPENTER, A. A.: Pelvic lipomatosis: successful surgical treatment, J. Urol. 110:397 (1973).
YALLA,S.V.,IVKER,M., BURROS,H. M.,andDo~~y, . Cystitis glandularis with perivesical lipomatosis, trelogy
5: 383 (1975).
MASSIVE
PROSTATIC
HYPERTROPHY
In the November issue (vol. 6, page To the Editor: 618) of UROLOGY, Milton E. Klinger, M.D., and Joseph DiMartini, M.D., discuss the subject of “Massive Prostatic Hypertrophy.” Please allow me to draw your attention to our publication on “Giant Prostate” which appeared in Urologia (33:317-321, 1966) and which evidently was overlooked by the authors. The patient described by us was seventy-five years of age. The prostate removed in a one-stage supra-
UROLOGY
! MAY1976 / VOLUMEVII, NUMBER5
BACTERIAL GROWTH IN URINE COLLECTED IN ILEAL LOOP RECEPTACLES The suppression of bacterial growth and ammonia formation in receptacles for urinary diversions described by K. Gerhard Brand, M.D., James R. Boen, Ph.D., and John F. Van Pilsum, Ph.D., in their article, “Suppression of Bacterial Growth and Ammonia Formation by Citrate Buffer in Urine Collected in Ileal Loop Receptacle,” published in the December issue (vol. 6, page 738) of UROLOGY, has definite potential advantages for patients. As they suggest, retarding the growth of bacteria in urine collection devices will apparently inhibit odor and reduce peristomal skin irritation. Further, this procedure may diminish the incidence of ascending urinary tract infections, formation of mucus (which plugs outlet valves) and crystallization of calcium on the appliance (which leads to stoma1 bleeding). However, eliminating the particularly offensive urease-producing bacteria that proliferate in alkaline urine can be accomplished by less complex methods of acidification than the citrate buffer used by these authors. Oral intake of ascorbic acid is an inexpensive and extremely easy means of achieving similar ends. Ingestion of vitamin C at doses in excess of 2 Gm. per day will maintain acidic pH or urine in most adults. This practice would eliminate the need for persons with urinary diversions to obtain the sodium citrate, mix and preserve the solution, and instill it into their appliance after each emptying. Although little is known about the metabolism of vitamin C or its potential for toxicity, there appear to be few contraindications to ingestion in excessive doses. Persons who have a high capacity to convert ascorbic acid to oxalate are rare but may be at risk for renal calcification if given high doses of vitamin C.* To the Editor:
Robin R. Young, R.N., M.S. Stoma Program Boston University School of Nursing Boston, Massachusetts 02215 *Briggs, M. H., Garcia-Webb,
P., and Davies, P.:
Urinary oxalate and vitamin C supplements, Lancet 2: 201 (1973).
PELVIC
LIPOMATOSIS
When commenting on their 3 cases of pelvic lipomatosis (UROLOGY, vol. 7, page 108), Stephen Radinsky, D.O., Editor Cabal, M.D., and
To the Editor:
566
John Shields, M.D., apparently failed to review the urologic literature. Perhaps as a result, several statements were made which I believe are in error. 1. Pelvic lipomatosis is frequently related to obesity. This relationship was first noted by Fogg and Smyth.’ Successful dietary treatment of pelvic lipomatosis was recently reported by Sacks and Drenick. 2 2. Surgical excision of the fatty tissue is possible and was first accomplished by Dr. Wyland Leadbetter. That patient, reported by me in 1973,3 continues to be well, and his hydronephrosis has subsided. 3. Renal function frequently deteriorates, particularly in younger people with this disease. Careful follow up of patients is necessary, and in addition, many of the patients have associated cystitis glandularis which theoretically has malignant potential.4 Perhaps a moritorium on further case reports is indicated until there have been significant advances in understanding the pathophysiology and treatment of this interesting disease. A. Alden Carpenter, M.D. 62 Columbian Street South Weymouth, Massachusetts 02199 References
FOGG, L. B., and SMYTH, J. W.:
Pelvic lipomatosis: a condition simulating pelvic neoplasm, Radiology 90: 558 (1968). SACKS,S.A., and DRENICK,E. J.: Pelvic lipomatosis: effect of diet, Urology 6: 609 (1975). CARPENTER, A. A.: Pelvic lipomatosis: successful surgical treatment, J. Urol. 110:397 (1973).
YALLA,S.V.,IVKER,M., BURROS,H. M.,andDo~~y, . Cystitis glandularis with perivesical lipomatosis, trelogy
5: 383 (1975).
MASSIVE
PROSTATIC
HYPERTROPHY
In the November issue (vol. 6, page To the Editor: 618) of UROLOGY, Milton E. Klinger, M.D., and Joseph DiMartini, M.D., discuss the subject of “Massive Prostatic Hypertrophy.” Please allow me to draw your attention to our publication on “Giant Prostate” which appeared in Urologia (33:317-321, 1966) and which evidently was overlooked by the authors. The patient described by us was seventy-five years of age. The prostate removed in a one-stage supra-
UROLOGY
! MAY1976 / VOLUMEVII, NUMBER5