Association between Development of Metabolic Acidosis and Improvement of Urinary Continence after Ileal Neobladder Creation

Müller, Guido; Butea-Bocu, Marius Cristian; Brock, Oliver; Hanske, Julian; Pucheril, Daniel; Noldus, Joachim; Otto, U.

doi:10.1097/ju.0000000000000583

Cited by 19 publications

(5 citation statements)

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“…When looking at drugs taken by UCB patients in detail, sodium bicarbonate was the most frequent. It is commonly prescribed to patients with ileal neobladder construction and metabolic acidosis; accordingly, most patients were in the RC group [35]. Drugs targeting blood coagulation were common, in agreement with findings that CVD is the most frequent co-morbidity in UCB patients [11,36].…”

Section: Discussionsupporting

confidence: 82%

The Characterization of Non-oncologic Chronic Drug Therapy in Bladder Cancer Patients and the Impact on Recurrence-Free and Cancer-Specific Survival: A Prospective Study

Strobach,

Haimerl,

Mannell

et al. 2023

JCM

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We aimed to characterize non-oncologic chronic drug therapy of bladder cancer (BC) patients and evaluate a possible impact on recurrence-free (RFS) and cancer-specific survival (CSS). Patients with a first diagnosis (FD) of BC or radical cystectomy (RC) were included in a prospective, monocentric, observational study. Drugs and medical data was assessed at start and three-monthly for 24 months. Drugs were classified by anatomical-therapeutic-chemical code (ATC). Endpoints for outcome analysis were RFS and CSS in univariate (Kaplan–Meier curves and log-rank test, Cox regression for Hazard Ratio (HR)) and multivariate (Cox regression models) analyses. Of 113 patients, 52 had FD and 78 RC. Median age was 74 and 72 years, 83% and 82% were male. Drugs of 114 ATC classes were taken by 48 (92%) FD patients (median number 4.5/IQR 2–7.5) and 73 (94%) of RC patients (median 5/IQR 2–9). In univariate analysis (log-rank test (p)/Cox regression (HR, 95% CI, p)), polypharmacy (p = 0.036/HR = 2.83, 95% CI = 1.02–7.90, p = 0.047), calcium channel blockers (p = 0.046/HR = 2.47, 95% CI = 0.97–6.27, p = 0.057) and proton pump inhibitors (p = 0.015/HR = 3.16, 95% CI = 1.18–8.41, p = 0.022) had a significant negative impact on RFS in RC patients, statins (p = 0.025/HR = 0.14, 95% CI = 0.02–1.06, p = 0.057) a positive effect on RFS in FD patients, angiotensin-converting enzyme inhibitors (p = 0.008/HR = 10.74, 95% CI = 1.20–96.17, p = 0.034) and magnesium (p = 0.042/HR = 5.28, 95% CI = 0.88–31.59, p = 0.067) a negative impact on CSS in FD patients. In multivariate analysis, the only significant drug effects were the negative impact of angiotensin-converting enzyme inhibitors (HR = 15.20, 95% CI = 1.30–177.67, p = 0.030) and magnesium (HR = 22.87, 95% CI = 1.57–333.81), p = 0.022) on CSS in FD patients, and the positive impact of statins (HR = 0.12, 95% CI = 0.01–0.97, p = 0.047) on RFS in FD patients. Impact of non-oncologic drugs on RFS and CSS was small in this prospective study. Thus, appropriate treatment of comorbidities is encouraged.

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Section: Discussionsupporting

confidence: 82%

The Characterization of Non-oncologic Chronic Drug Therapy in Bladder Cancer Patients and the Impact on Recurrence-Free and Cancer-Specific Survival: A Prospective Study

Strobach,

Haimerl,

Mannell

et al. 2023

JCM

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“…Metabolic acidosis is common after orthotopic neobladder formation, and whether its incidence was associated with urinary continence was assessed by M€ uller et al (page 585) from Germany. 9 A median of 29 days after surgery 58% of patients in this retrospective series had metabolic acidosis. The need for oral sodium bicarbonate for the acidosis increased in 45% to 86% of patients as urinary continence improved.…”

Section: Metabolic Acidosis and Urinary Continencementioning

confidence: 75%

This Month in Adult Urology

Smith¹

2020

Journal of Urology

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Patients should be involved in treatment decisions but it is often difficult for them to make an informed choice. Recognized experts may disagree, information on the internet can be suspect and physicians often incompletely suppress their own biases. Nowhere is this more true than in treatment of prostate cancer. Once a patient has decided on surgery, there are different surgical approaches to consider. A patient may come to regret a decision, especially if the outcome is different than expected.Baunacke et al (page 554) from Germany evaluated decision regret after radical prostatectomy in a cohort of 1,260 patients, and overall decision regret was low. 1 Erectile function, urinary continence and freedom from recurrence correlated with regret but surgical approach did not. An active role in decision making led to lower regret. The surgeon plays a highly influential role in informed consent and patients should be intimately involved in the process. A well informed patient is less likely to regret a decision even if things do not turn out completely as expected.

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“…The advantages of pouches include indeed the improved urinary continence and a more natural voiding pattern. Conversely, these procedures are technically more complex and require longer operative time with an increasing risk of complications, which are mostly related to urinary leakage, metabolic imbalances and long-term concerns such as pouchitis or secondary malignancy [69,138,139]. Additionally, careful patient selection and counseling are crucial considering that not all patients are suitable candidates for pouch reconstruction due to factors such as cognitive function, manual dexterity and willingness to comply with self-catheterization or voiding schedules [140].…”

Section: Discussionmentioning

confidence: 99%

Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction—A Comprehensive Review

Barone,

Napolitano,

Reccia

et al. 2024

JPM

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Bladder cancer ranks as the 10th most prevalent cancer globally with an increasing incidence. Radical cystectomy combined with urinary diversion represents the standard treatment for muscle-invasive bladder cancer, offering a range of techniques tailored to patient factors. Overall, urinary diversions are divided into non-continent and continent. Among the first category, cutaneous ureterostomy and ileal conduit represent the most common procedures while in the second category, it could be possible to describe another subclassification which includes ureterosigmoidostomy, continent diversions requiring catheterization and orthotopic voiding pouches and neobladders. In this comprehensive review, urinary diversions are described in their technical aspects, providing a summary of almost all alternatives to urinary diversion post-radical cystectomy.

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Association between Development of Metabolic Acidosis and Improvement of Urinary Continence after Ileal Neobladder Creation

Cited by 19 publications

References 0 publications

The Characterization of Non-oncologic Chronic Drug Therapy in Bladder Cancer Patients and the Impact on Recurrence-Free and Cancer-Specific Survival: A Prospective Study

The Characterization of Non-oncologic Chronic Drug Therapy in Bladder Cancer Patients and the Impact on Recurrence-Free and Cancer-Specific Survival: A Prospective Study

This Month in Adult Urology

Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction—A Comprehensive Review

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