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Metabolic Complications of Urinary Diversions: An Overview
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RENAL TUMORS,RETROPERITONEUM, URETER, AND URINARY DIVERSION AND RECONSTRUCTION
positivity was significantly correlated with microvessel density. TP expression was correlated with tumor grade, but there was no significant association between TP expression and other clinicopathologic characteristics. TP expression as a prognostic variable was studied using Cox’s proportional hazards model. TP overexpression was an independent prognostic factor (hazards ratio, 3.95; 95% confidence interval, 0.98 to 15.89; P = .039) as were nodal category, metastases category, tumor grade, and venous invasion. Conclusion: These findings suggest that TP expression is correlated with microvessel density in RCC and is an unfavorable independent prognostic factor. The future development and characterization of TP inhibitors may provide a novel approach to the therapy of RCC. Reprinted with permission from American Society of Clinical Oncology.
Editorial Comment: Thymidine phosphorylase seems identical to platelet-derivedendothelial growth factor. It seems to have angiogenic properties and is associated with microvessel density. A total of 131 patients were evaluated. Expression of messenger ribonucleic acid for vascular endothelial growth factor was increased in 26 of 27 renal cancers. In this tumor system microvascular density did not correlate with local invasion or distant metastases, which may be due to the high incidence of hypervascular renal cell carcinomas. Thymidine phosphorylase expression is still associated with a poorer prognosis and may be helpful in the future as a marker. Fray F. Marshall, M.D. Metabolic Complications of Urinary Diversions: An Overview
D. N. CRUZAND S. J. Hum, Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut h e r . J. Med., 102: 477-484, 1997 Patients with urinary diversions present unique challenges to internists who have an important role in their long-term management. Advances in surgical techniques over the past 30 years have given rise to a number of urinary diversion procedures that use various intestinal segments. In its normal function, the intestine absorbs water and solutes. When placed in contact with the urinary stream, the intestine can create numerous metabolic abnormalities. These include bone disease, hepatobiliary disease, infection, malignancy, neurologic complications, nutritional deficiencies, and a number of electrolyte and acid-base disorders. An overview of these metabolic abnormalities and their causes is provided, as well as recommendations for screening and management of patients. Editorial Comment: The authors summarize the metabolic complications of urinary diversion. Metabolic complications are usually more prominent with neobladders or reservoirs than conduits. Bone disease, hepatic dysfunction or other nutritional abnormalitiesare well recognized, as well as infection and malignancy. Adults who are otherwise normal and have excellent renal function seem to tolerate many of these metabolic changes well for a long period. We are now seeing patients return at 8 to 10 years following neobladder reconstruction, and they have usually fared well from the standpoint of metabolic complications. Many complications may be insidious, such as malignancy or vitamin B12 deficiency, and careful followup is still warranted. This article is recommended for urologists who perform neobladder reconstruction and want a good summary of the metabolic consequences of urinary diversion. Fray F. Marshall, M.D.
RENAL TUMORS,RETROPERITONEUM, URETER, AND URINARY DIVERSION AND RECONSTRUCTION
positivity was significantly correlated with microvessel density. TP expression was correlated with tumor grade, but there was no significant association between TP expression and other clinicopathologic characteristics. TP expression as a prognostic variable was studied using Cox’s proportional hazards model. TP overexpression was an independent prognostic factor (hazards ratio, 3.95; 95% confidence interval, 0.98 to 15.89; P = .039) as were nodal category, metastases category, tumor grade, and venous invasion. Conclusion: These findings suggest that TP expression is correlated with microvessel density in RCC and is an unfavorable independent prognostic factor. The future development and characterization of TP inhibitors may provide a novel approach to the therapy of RCC. Reprinted with permission from American Society of Clinical Oncology.
Editorial Comment: Thymidine phosphorylase seems identical to platelet-derivedendothelial growth factor. It seems to have angiogenic properties and is associated with microvessel density. A total of 131 patients were evaluated. Expression of messenger ribonucleic acid for vascular endothelial growth factor was increased in 26 of 27 renal cancers. In this tumor system microvascular density did not correlate with local invasion or distant metastases, which may be due to the high incidence of hypervascular renal cell carcinomas. Thymidine phosphorylase expression is still associated with a poorer prognosis and may be helpful in the future as a marker. Fray F. Marshall, M.D. Metabolic Complications of Urinary Diversions: An Overview
D. N. CRUZAND S. J. Hum, Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut h e r . J. Med., 102: 477-484, 1997 Patients with urinary diversions present unique challenges to internists who have an important role in their long-term management. Advances in surgical techniques over the past 30 years have given rise to a number of urinary diversion procedures that use various intestinal segments. In its normal function, the intestine absorbs water and solutes. When placed in contact with the urinary stream, the intestine can create numerous metabolic abnormalities. These include bone disease, hepatobiliary disease, infection, malignancy, neurologic complications, nutritional deficiencies, and a number of electrolyte and acid-base disorders. An overview of these metabolic abnormalities and their causes is provided, as well as recommendations for screening and management of patients. Editorial Comment: The authors summarize the metabolic complications of urinary diversion. Metabolic complications are usually more prominent with neobladders or reservoirs than conduits. Bone disease, hepatic dysfunction or other nutritional abnormalitiesare well recognized, as well as infection and malignancy. Adults who are otherwise normal and have excellent renal function seem to tolerate many of these metabolic changes well for a long period. We are now seeing patients return at 8 to 10 years following neobladder reconstruction, and they have usually fared well from the standpoint of metabolic complications. Many complications may be insidious, such as malignancy or vitamin B12 deficiency, and careful followup is still warranted. This article is recommended for urologists who perform neobladder reconstruction and want a good summary of the metabolic consequences of urinary diversion. Fray F. Marshall, M.D.