Genitourinary Complications of Inflammatory Bowel Disease

Extraintestinal manifestations of inflammatory bowel disease include several affecting the genitourinary system.

• Fistulas: Seen in 2%-8% of patients. Fistulas most commonly originate from the ileum (60%), but can arise from the colon (20%), and rectum (10%), as well as multiple sites (10%). The vast majority of fistuals terminate in the urinary bladder (90%). Other sites include the urethra (5%) as well as the urachus and ureter.
• Nephrolithiasis: 2%-6% prevalence. More common in Crohn disease. Calcium-oxalate stones are typical and are due increased intestinal absorption of oxalate. Uric acid calculi may also be seen. These develop in acidic urine and are caused by increased uric acid absorption in injured colon.
• Acalculus uretheral obstruction: More common on the right. Due to adherence and compression by inflamed terminal ileum
• Renal amyloidosis: Seen in about 1% of patients, more commonly in Crohn disease. Thought to be due to acute phase reaction proteins
• Glomerulonephritis: Responsive to therapy for inflammatory bowel disease.

References

Danese S, Semeraro S, Papa A, Roberto I, Scaldaferri F, Fedeli G, Gasbarrini G, Gasbarrini A. Extraintestinal manifestations in inflammatory bowel disease. World J Gastroenterol. 2005 Dec 14;11(46):7227-36.