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URINARY IMMUNOGLOBULINS IN PATIENTS WITH CONTINENT URINARY RESERVOIRS AND ILEAL CONDUITS
Author(s) -
Terai Akito,
Arai Yoichi,
Kawakita Mutsushi,
Okada Yusaku,
Yoshida Osamu
Publication year - 1995
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.1995.tb00447.x
Subject(s) - urinary system , urine , medicine , urinary diversion , upper urinary tract , pouch , urology , gastroenterology , surgery , cystectomy , bladder cancer , cancer
Background: Although bowel segments are commonly used for reconstructing the urinary tract, a high incidence of bacteriuria is observed in patients with urinary intestinal diversion. The normal gastrointestinal tract possesses a potent mucosal immune system characterized by secretory immunoglobulin A (slgA) as the major humoral defense factor. However, the significance of urinary IgA secretion as the mucosal defense mechanism in patients with urinary intestinal diversion has remained obscure. In this study, urinary levels of slgA as well as serum‐type IgA were measured in patients with continent urinary reservoirs (Kock and Indiana pouches) and ileal conduits. Methods: Twenty‐four‐hour urine samples were collected in a total of 80 patients with urinary intestinal diversion (22 Kock pouch patients, 21 Indiana pouch patients and 37 ileal conduit patients). The amount of slgA and serum‐type IgA were measured by enzyme‐linked immunosorbent assay (ELISA). Results: Urinary IgA levels showed great inter‐ and intra patient variability in all three groups. Indiana reservoir urine contained significantly greater amounts of slgA (mean 32.0 mg/24hrs) than Kock reservoir urine (11.9 mg) and conduit urine (4.9 mg), whereas Kock reservoir urine contained significantly more slgA than conduit urine. However, the corresponding difference was not observed in regard to serum‐type IgA. In none of the three modes of urinary diversion did 24‐hour slgA excretion show any correlation with the length of time after surgery. Conclusions: Since the amounts of slgA in these patients were much greater than reported in urinary tract infection as well as in normal subjects, the major portion of urinary slgA seemed to be secreted by the intestinal segments. Long‐term slgA secretion in urinary intestinal diversion, especially continent urinary reservoirs, may be an important host defense system.