Abstract
Purpose
To evaluate the necessity of chronic alkali therapy in non-complicated orthotopic ileal neobladders with normal renal function.
Materials and methods
This is a prospective study that included 200 male patients who underwent radical cystectomy and ileal W neobladder for invasive bladder carcinoma between January 1993 and December 2013. The studied patients included 100 consecutive patients who were maintained on regular alkali therapy since surgery and 100 consecutive patients who stopped the use of alkali treatment after initial 3 months postoperative with minimum postoperative observation time of 1 year. All patients had satisfactory function of the reservoirs with normal upper tract. The patients were subjected to blood analysis for creatnine, electrolytes, pH and bicarbonate and urine chemical analysis. The study also included 40 healthy male age-matched volunteers who served as a control group.
Results
Both groups were comparable as regard age, BMI, follow-up period and surgical technique. There were no significant differences between both groups as regard serum creatnine, electrolytes blood pH and bicarbonate and the mean values were within normal range; however, the neobladder patients are still toward the acidotic side in comparison to healthy volunteers. Also there were no significant differences between both groups of patients as regard urine pH and excretion of electrolytes, calcium, phosphorus and creatnine.
Conclusion
Patients with non-complicated ileal neobladders with normal upper tract who were not maintained on alkali prophylaxis for long period have a compensated acid base status. Therefore, the prolonged alkali prophylaxis is not mandatory.
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References
Hautmann RE, Abol-Enein H, Hafez K et al (2007) Urinary diversion. Urology 69(1 Suppl):17–49
Abol-Enein H, Ghoneim MA (2001) Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: experience with 450 patients. J Urol 165(5):1427–1432
McDougal WS (1992) Metabolic complications of urinary intestinal diversion. J Urol 147(5):1199–1208
Hautmann RE, de Petriconi RC, Volkmer BG (2011) 25 years of experience with 1,000 neobladders: long-term complications. J Urol 185(6):2207–2212
Studer UE, Burkhard FC, Schumacher M et al (2006) Twenty years experience with an ileal orthotopic low pressure bladder substitute—lessons to be learned. J Urol 176(1):161–166
Varol C, Studer UE (2004) Managing patients after an ileal orthotopic bladder substitution. Br J Urol 93(3):266–270
Stein R, Rubenwolf P (2014) Metabolic consequences after urinary diversion. Front Pediatr 2:15
Boyd SD, Schiff WM, Skinner DG, Lieskovsky G, Kanellos AW, Klimaszewski AD (1989) Prospective study of metabolic abnormalities in patient with continent Kock pouch urinary diversion. Urology 33(2):85–88
Tanrikut C, McDougal WS (2004) Acid-base and electrolyte disorders after urinary diversion. World J Urol 22(3):168–171
Giannini S, Nobile M, Sartori L et al (1997) Bone density and skeletal metabolism in patients with orthotopic ileal neobladder. J Am Soc Nephrol 8(10):1553–1559
Gupta A, Atoria CL, Ehdaie B et al (2014) Risk of fracture after radical cystectomy and urinary diversion for bladder cancer. J Clin Oncol 32(29):3291–3298
Mills RD, Studer UE (1999) Metabolic consequences of continent urinary diversion. J Urol 161(4):1057–1066
Stein R, Fisch M, Andreas J, Bockisch A, Hohenfellner R, Thuroff JW (1998) Whole-body potassium and bone mineral density up to 30 years after urinary diversion. Br J Urol 82(6):798–803
Chang SS, Koch MO (2000) The metabolic complications of urinary diversion. Urol Oncol 5(2):60–70
Hautmann RE, Egghart G, Frohneberg D, Miller K (1988) The ileal neobladder. J Urol 139(1):39–42
Abol-Enein H, Ghoneim MA (1994) A novel uretero-ileal reimplantation technique: the serous lined extramural tunnel. A preliminary report. J Urol 151(5):1193–1197
Bakke A, Jensen KM, Jonsson O et al (2007) The rationale behind recommendations for follow-up after urinary diversion: an evidence-based approach. Scan J Urol Nephrol 41(4):261–269
Poulsen AL, Steven K (1996) Acid-base metabolism after bladder substitution with the ileal urethral Kock reservoir. Br J Urol 78(1):47–53
Poulsen AL, Overgaard K, Steven K (1997) Bone metabolism following bladder substitution with the ileal urethral Kock reservoir. Br J Urol 79(3):339–347
Terai A, Arai Y, Kawakita M, Okada Y, Yoshida O (1995) Effect of urinary intestinal diversion on urinary risk factors for urolithiasis. J Urol 153(1):37–41
Racioppi M, D’Addessi A, Fanasca A et al (1999) Acid-base and electrolyte balance in urinary intestinal orthotopic reservoir: ileocecal neobladder compared with ileal neobladder. Urology 54(4):629–635
Roosen A, Gerharz EW, Roth S et al (2004) Bladder, bowel and bones: skeletal changes after intestinal urinary diversion. World J Urol 22:200–209
Tschopp AB, Lippuner K, Jaeger P, Merz VW, Danuser H, Studer UE (1996) No evidence of osteopenia 5 to 8 years after ileal orthotopic bladder substitution. J Urol 155(1):71–75
Campanello A, Herlitz H, Lindstedt G et al (1996) Bone mineral and related biochemical variables in patients with Kock ileal reservoir or Bricker conduit for urinary diversion. J Urol 155(4):1209–1213
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Osama Mahmoud, Ahmed El-Assmy, Mohamed Kamal, Albeer Ashamallah and Hassan Abol-Enein declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Mahmoud, O., El-Assmy, A., kamal, M. et al. Is chronic alkali therapy in orthotopic ileal neobladders necessary? A prospective controlled study. Int Urol Nephrol 49, 49–53 (2017). https://doi.org/10.1007/s11255-016-1447-0
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DOI: https://doi.org/10.1007/s11255-016-1447-0