Adenocarcinoma at the site of ureterosigmoidostomies for exstrophy of the bladder

Adenocarcinoma of the colon is a rare complication of ureterosigmoidostomy done for exstrophy of the bladder. Only 13 cases have been previously reported, occurring from 10 to 46 yr after the procedure. In a series of 150 patients who have had ureterosigmoidostomies carried out at the Children's Hospital Medical Center, Boston, over the past 40 yr, 4 patients have been treated at our institution for this complication. The tumor was noted 20 to 32 yr after the initial procedure. Two patients are alive and well 1 and 4 yr after resection. The increasing incidence of this complication with advancing age will require careful observation and will undoubtedly influence the indications for the procedure. An additional question of great importance is how to evaluate and follow the thousands of patients who have had this procedure done at one time in their lives. It is suggested that an annual intravenous pyelogram is indicated in those patients with functioning ureterostomies and that a colonoscopy to the level of the anastomoses be carried out at 6-mo intervals in all patients. In those patients in whom the ureterosigmoidostomies have been taken down, a sleeve resection of that area of the colon should be strongly considered.