Morphologic Changes in Ileal Reservoir Mucosa after Long-Term Exposure to Urine: A Study in Patients with Continent Urostomy (Kock Pouch)

In patients with supravesical urinary diversion, continent ileal reservoirs utilized for urinary collection were examined by endoscopy at intervals of 1 month to 9 years after surgical construction, and biopsy specimens were obtained for light microscopy and morphometry. The gross appearance of the mucosa showed alterations in the shape of the shorter and broader finger-like villi during the first postoperative month to the subsequent very low ridges and convolutions or, in some instances, flat mucosa devoid of individual villi. Starting between 1 and 3 years after the surgical construction, endoscopically smooth1 areas were encountered in caudal areas of the reservoir, and the areas were mixed with islands of villous mucosa. Microscopically and morphometrically, the specimens from villous areas confirmed reduction in villous height and increase in crypt depth, whereas no changes were seen in the epithelial mitotic frequency. The number of mucus-storing goblet cells increased already within 1 month after ...