Abstract
Among the 127 patients who underwent surgical treatment for Crohn's disease at Tohoku University Hospital, urinary complications were noted in 13 patients (10.2%), including urolithiasis in 6 patients (4.7%), a ureteral obstruction in 4 (3.1%), and urinary fistula in 3 (2.4%). In patients with urolithiasis, conservative therapy was effective. An ureteral obstruction was detected on the right side in all 4 of these cases because of the inflamed terminal ileum. In 2 of the 4 cases, the symptoms improved by either preoperative total parenteral nutrition or elemental diet therapy. A resection of the inflamed intestine was necessary in all cases. In patients with urinary fistulas, a resection of the inflamed intestine combined with a reconstruction of the urinary tract was carried out after total parenteral nutrition. In conclusion, conservative therapy with preoperative total parenteral nutrition or elemental diet therapy proved to be effective for a ureteral obstruction since it improved the intestinal inflammation. As a definitive treatment, surgery is still necessary for the management of urinary fistulas and ureteral obstruction. Based on our findings, patients with urolithiasis in Crohn's disease should thus be treated conservatively in the same way as patients without Crohn's disease.
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Rankin GB (1990) Extraintestinal and systemic manifestations of inflammatory bowel disease. Med Clin North Am 74:39–50
Banner MP (1987) Genitourinary complications of inflammatory bowel disease. Radiol Clin North Am 25:199–209
Matsumiya K, Miyake O, Hosomi M, Oka T, Takaha M, Nakayama H, Kikkawa N, Terada A, Murai M (1989) Hydronephrosis caused by Crohn's disease: a case report—review of 41 cases with urinary tract complication reported in Japan (in Janapese with English abstract). Hinyo Kiyo (Acta Urol Jpn) 35:863–869
The Japanese Research Committee for Crohn's disease (Chairman: Yamagata S) (1979) Crohn's disease in Japan. Gastroenterol Jpn 14:366–373
Ten Kate J (1936) Twee gevallen van ileitis terminalis (Two cases of ileitis terminalis). Ned Tijdschr Geneeskd 80:5660–5664
Hyams HC, Weingberg SR, Alley JL (1943) Chronic ileitis with concomitant ureteritis: case report. Am J Surg 61:117–120
Bagby RJ, Clements JL, Patrick JW, Rogers JV, Weens HS (1973) Genitourinary complications of granulomatous bowel disease. Am J Roentgenol Radium Ther Nucl Med 117:297–306
Greenstein AJ, Janowitz HD, Sachar DB (1976) The extraintestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients. Medicine 55:401–412
Smith LH, Fromm H, Hofmann AF (1972) Acquired hyperoxaluria, nephrolithiasis, and intestinal disease: description of a syndrome. N Engl J Med 286:1371–1375
Chadwick VS, Modha K, Dowling RH (1973) Mechanism of hyperoxaluria in patients with ileal dysfunction. N Engl J Med 289:172–176
Fukushima T, Ishiguro N, Matsuda Y, Takemura H, Tsuchiya S (1982) Clinical and urinary characteristics of urolithiasis in ulcerative colitis. Am J Gastroenterol 77:238–242
Shield DE, Lytton B, Weiss RM, Schiff MJ (1976) Urologic complications of inflammatory bowel disease. J Urol 115:701–706
Block GE, Enker WE, Kirsner JB (1973) Significance and treatment of occult obstructive uropathy complicating Crohn's disease. Ann Surg 178:322–332
Siminovitch JM, Fazio VW (1980) Ureteral obstruction secondary to Crohn's disease: a need for ureterolysis. Am J Surg 139:95–98
Kyle J, Murray CM (1969) Ileovesical fistula in Crohn's disease. Surgery 66:497–501
Talamini MA, Broe PJ, Cameron JL (1982) Urinary fistulas in Crohn's disease. Surg Gynecol Obstet 154:553–556
Greenstein AJ, Sachar DB, Tzakis A, Sher L, Heimann T, Aufses AHJ (1984) Course of enterovesical fistulas in Crohn's disease. Am J Surg 147:788–792
Smith PJB, Williams RE, DeDombal AT (1972) Genitourinary fistulae complicating Crohn's disease. Br J Urol 44:657–661
Badlani G, Abrams HJ, Levin L (1980) Enterovesical fistulas in Crohn disease. Urology 6:599–600
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Sato, S., Sasaki, I., Naito, H. et al. Management of urinary complications in Crohn's disease. Surg Today 29, 713–717 (1999). https://doi.org/10.1007/BF02482314
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DOI: https://doi.org/10.1007/BF02482314