Urologic Oncology: Seminars and Original Investigations
Review articleThe metabolic complications of urinary diversion
Section snippets
Reconstruction with small and large intestine
Small and large intestinal segments have been used more frequently than any other segments and in various configurations, including ureterosigmoidostomy, ileal and colon conduits, continent cutaneous intestinal pouches, orthotopic neobladders, and enterocystoplasty. Jejunal segments have been used exclusively as conduits, but they are chosen infrequently and usually in the absence of a suitable alternative, such as in high-risk patients who have received pelvic radiotherapy and have limited
Reconstruction with gastric segments
The use of stomach for lower urinary tract reconstruction was introduced experimentally in dogs by Sinaiko in 1956 [77], but has recently received attention as an acceptable and even favorable alternative to the use of small and large intestine in children with renal insufficiency [78]. Several technical and metabolic advantages in the use of stomach for augmentation cystoplasty or orthotopic reconstruction have been described. The metabolic benefits of utilizing stomach include compensation
Summary
The spectrum of potential metabolic complications encountered after urinary reconstruction is dictated by the type of gastrointestinal tissue used. No segment of intestine is without metabolic disadvantages. In each circumstance, the metabolic derangements seen are predictable based on known principles of gastrointestinal physiology and the normal electrolyte composition of urine. Practical management of these clinical syndromes is most easily understood if this physiology is considered. The
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2018, Urologic Oncology: Seminars and Original InvestigationsMetabolic and Nutritional Consequences of Urinary Diversion Using Intestinal Segments to Reconstruct the Urinary Tract
2018, Urologic Clinics of North AmericaCitation Excerpt :The nutritional complications of UD with large segments of ileum or colon are generally predictable and result from the loss of the normal function of these segments in the normal intestinal tract. The latter half of the ileum is largely responsible for the absorption of vitamin B12, fatty acids, bile salts, and multiple other nutrients.13–16 B12 receptors are located in the distal three-fifths of ileum, but are most densely located in the terminal 3 to 5 feet of this segment of the intestinal tract.
Ileal Neobladder: An Important Cause of Non-Anion Gap Metabolic Acidosis
2017, Journal of Emergency MedicineCitation Excerpt :The outcome of the surgery is that urine dwells in a neobladder made of gastrointestinal mucosa, which, unlike normal bladder mucosa, is physiologically adept at absorption and solute exchange. As the urine sits in an ileal neobladder, the gastrointestinal mucosal sodium-hydrogen antiporter will secrete sodium in exchange for hydrogen ions, and bicarbonate will be excreted in exchange for chloride absorption through an exchange port (6). This leads to a net gain of hydrogen ion and chloride, and a loss of bicarbonate from the body into the urine, resulting in a non-anion gap metabolic acidosis.
Characterization of Standard Urine Properties in Noncomplicated Orthotopic Ileal Neobladders: A Prospective Controlled Study
2016, UrologyCitation Excerpt :The higher urinary pH in the diverted patients (mean 5.6 ± 0.7) than in the control group (mean 5.3 ± 0.4) copes well with all the previous studies.6,7 This is explained by the absorption of ammonium and bicarbonate secretion,5 but the mean pH is still acidic and within the normal range. Proteinuria was diagnosed in 43% of the diverted group compared with only 7.5% in the control group (P < .001).
Bone and metabolic complications of urinary diversions
2015, Endocrinologia y Nutricion