Metabolic and functional consequences of urinary reconstruction with bowel

Gerharz, Elmar W.; Turner, William H.; Kälble, T.; Woodhouse, Christopher

doi:10.1046/j.1464-410x.2003.04000.x

Cited by 84 publications

(66 citation statements)

References 67 publications

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“…Acidosis results because intestinal segments retain their absorptive and secretory properties such as the absorption of ammonium, chloride, potassium and urea as well as the secretion of bicarbonate and sodium [8,10,13] . The frequency and severity of metabolic acidosis are mainly related to the type and length of the intestinal segment used [14] .…”

Section: Discussionmentioning

confidence: 99%

“…The preservation of renal function is considered both the ultimate goal and an essential prerequisite of successful enterocystoplasty [8] but, to our knowledge, no histological renal change is reported as a consequence of metabolic alteration after enterocystoplasty. Our aim was to evaluate, in a mid-and long-term follow-up, the urinary, metabolic, renal and enteropatch changes after experimental ileocystoplasty in rats.…”

Section: Introductionmentioning

confidence: 90%

“…Bladder augmentation predisposes the patient to many adverse events such as infections, bladder stones, hyperchloremic metabolic acidosis and even cancers [8][9][10] . In this regard, an incidence of transitional cell carcinoma of 4-27% is reported and an incidence of proliferative lesions in 36-54% of ileocystoplasty in rats [7,11,12] .…”

Section: Introductionmentioning

confidence: 99%

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Ileocystoplasty in Rats: Metabolic, Renal and Enteropatch Changes in a Mid- and Long-Term Follow-Up

Arena

Arena²,

Fazzari³

et al. 2011

Urol Int

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Introduction: Bladder augmentation predisposes humans to many metabolic, renal and enteropatch changes. Our aim was to evaluate in a rat model of ileocystoplasty mid- and long-term urinary, metabolic, renal and graft changes. Materials and Methods: We performed an ileocystoplasty and a sham operation in 30 rats. Seven augmented rats and 3 sham-operated animals were euthanized after 1, 3 and 6 months. We performed urinalysis, urine culture and blood sampling for serum electrolytes and urea. Histopathological changes of the ileal patch and kidneys were also evaluated. Results: The urine cultures were positive in 14.3, 57 and 71%, respectively, 1, 3 and 6 months after surgery. Urinary pH, serum chloride and urea of the augmented group were significantly higher. Bladder calculi were formed in 23.8% of ileocystoplasty. Histopathological examination showed urothelialization of the graft with hyperplastic/metaplastic changes. The kidneys showed glomerular depletion and a marked distal tubular ectasia. Conclusions: Our data showed that, in a mid- and long-term follow-up, rat bladders subjected to ileocystoplasty displayed hyperchloremic metabolic acidosis, electrolyte imbalance, enhanced serum blood urea levels and glomerular/tubular changes. Hyperplastic and/or metaplastic changes at the junctional zone were observed. Our experimental results suggest that frequent monitoring of renal function and surveillance of humans who have undergone ileocystoplasty are recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

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Ileocystoplasty in Rats: Metabolic, Renal and Enteropatch Changes in a Mid- and Long-Term Follow-Up

Arena

Arena²,

Fazzari³

et al. 2011

Urol Int

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“…However, others argue that yearly endoscopy is not cost effective and the potential morbidity makes it an ineffective screening procedure (78,79). A decision analysis performed by Kokorowski et al determined that annual screening cystoscopy and cytology were not cost-effective (80).…”

Section: Malignancymentioning

confidence: 99%

Long-Term Sequela of Pediatric Bladder Reconstruction

Roth

Keenan

Cain

et al. 2015

Curr Bladder Dysfunct Rep

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Children with refractory neurogenic bladder (NGB) who have failed maximal medical management are presented with options for bladder reconstruction. It is critical to understand the long-term sequela of bladder augmentation and bladder neck reconstruction to properly counsel families regarding these procedures. Benefits may include preservation of renal function, continence, reduced risk of renal-related mortality and potential improvements in quality of life (QOL). However, these advantages must be balanced with the risks of bladder calculi, perforation, need for additional surgery, acid/base disturbances, vitamin B12 deficiency and malignancy. Therefore, careful patient selection and preoperative counseling are paramount for those undergoing bladder reconstruction which includes intestinal bladder augmentation, as these patients require lifelong vigilant follow-up. IntroductionChildren with neurogenic bladders (NGB) are initially managed with clean intermittent catheterization (CIC) and anticholinergic medications in order to maintain a sizable, continent, and compliant urinary reservoir. Despite early and aggressive intervention, some patients undergo lower urinary tract reconstruction (bladder augmentation, catheterizable channel and/or bladder neck reconstruction) to protect their upper tracts and achieve continence. In a few select patients with favorable urodynamics (UDS) and low outlet resistance, a bladder neck procedure (BNP) can be performed without bladder augmentation to achieve continence. Myelodysplasia, specifically spina bifida (SB), remains the most common etiology of NGB in the pediatric population. Due to medical advances, particularly in the realm of Urology, more SB patients with bladder reconstruction are surviving into adulthood. We review current literature regarding long-term sequela of bladder reconstruction in pediatric patients with neurogenic bladder, with a primary focus on bladder augmentations for refractory NGB secondary to SB.

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“…Moreover, because of osmotic gradient, the ileal reservoir may lose quite a lot of water into the lumen while, on the other direction, some drugs (antibiotics, methotrexate, etc.) or their active metabolites may be reabsorbed, thus it increasing toxicity towards the liver, as its pivotal role in drug metabolism, and the kidney as excretory target organ (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Whyever bladder tissue engineering clinical applications still remain unusual even though many intriguing technological advances have been reached?

Alberti¹

2016

Gchir

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IntroductionAbout the bladder reconstructive surgery -from bladder augmentation cystoplasty to orthotopic whole neobladder -the use of autologous bowel segments, though with the onset sometimes of both prosthetic malignancies and systemic metabolic complications, still remains the gold standard since no better alternative has been proved to be wholly reliable.With regard to such pathomorphosic and malignant complications, clinical and animal model histologic examinations on prosthetic intestinal segments may at times show a sequential pathway from chronic urine exposure-related inflammatory conditions to malignant transformation, given that phlogogenic cells can also overexpress cancerogenic cytokines. Besides the adenocarcinoma, other tumors -including polypoid adenoma, signet ring carcinoma, transitional cell carcinoma, sarcoma, lymphoma and carcinoid -may affect the intestinal urinary diversion, particularly that colonic rather than the ileal one. Preternatural histotectonic connections between ureteral transitional epithelium and paranastomotic intestinal mucosa most likely explain, through altered cell growth signalling between two dissimilar cell compartments, the prevailing appearance of malignant changes just at the uretero-intestinal suture line (1-4).Systemic metabolic imbalances of intestinal urinary diversion arise from both the chronic exposure of bowel to urine -response to excess of urinary NH4, H + , Clabsorption with developing iperchloremic acidosis, whence hypokalemia, bone demineralization with resulting hyperphosphatemia/hyperphosphaturia and phosphate urinary stone formation (that's made easier given the mucus overexpression) -and, otherwise, the reconstructive measure-due removal of ileal segment with following chologenic diarrhoea/steatorrhoea, hype-

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Metabolic and functional consequences of urinary reconstruction with bowel

Cited by 84 publications

References 67 publications

Ileocystoplasty in Rats: Metabolic, Renal and Enteropatch Changes in a Mid- and Long-Term Follow-Up

Ileocystoplasty in Rats: Metabolic, Renal and Enteropatch Changes in a Mid- and Long-Term Follow-Up

Long-Term Sequela of Pediatric Bladder Reconstruction

Whyever bladder tissue engineering clinical applications still remain unusual even though many intriguing technological advances have been reached?

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