Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 4, July-August, p. 633–638

Publication type: review article

Language: English

Urinary Diversion Metabolic Complications – Underestimated Problem

Wojciech Krajewski1,D, Radosław Piszczek1,D, Magdalena Krajewska2,D, Janusz Dembowski1,E, Romuald Zdrojowy1,F

1 Department and Clinic of Urology, Wroclaw Medical University, Poland

2 Department and Clinic of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland

Abstract

Bladder cancer is one of the most frequent human cancers. In 2011 more than six thousand people in Poland developed BC and more than three thousand died because of it. Treatment of bladder cancer depends on its stage. In less advanced tumours (Ta, Tcis, T1) transurethral resection of bladder tumor with adjuvant immunotherapy is often therapeutic. In more advanced cases (≥ T2) radical cystectomy is needed. There are several surgical types of postcystectomy urinary diversion divided into two fundamental types – enabling and not enabling urine continence. The most common procedures include ureterocutaneostomy, ileal or colon conduit, orthopic ileal bladder, heterotopic continent bladder replacement (pouch) and urinary diversion via the rectum. Depending on type of cystectomy, various metabolic complications occur, because the absorptive-secretory function of used bowel segment is intact. Complications include bowel dysfunction, malabsorption of various vitamins, acid-base imbalance, electrolyte imbalance, abnormalities in bone metabolism, formation of renal calculi, secondary malignancies and disturbances in function of kidneys or liver. Early diagnosed complications can be treated easier, recognised in advanced stages are often irreversible. In our paper we present review of different approaches to bladder cancer treatment and metabolic complications occurring after these procedures.

Key words

bladder cancer, urinary diversion, metabolic complications.

References (40)

  1. Centrum Onkologii w Warszawie. Krajowa baza danych nowotworowych. In: Warszawa 2014. http://epid.coi. waw.pl/krn/Dostęp z dnia 10.03.2014
  2. Brennan P, Bogillot O, Cordier S, Greiser E, Schill W, Vineis P, Lopez-Abente G, Tzonou A, Chang-Claude J, Bolm-Audorff U: Cigarette smoking and bladder cancer in men: a pooled analysis of 11 case-control studies. Int J Cancer 2000, 86, 289–294.
  3. Griffiths TR, Action on Bladder C: Current perspectives in bladder cancer management. Int J Clin Pract 2013, 67, 435–448.
  4. Kolodziej A, Dembowski J, Zdrojowy R, Wozniak P, Lorenz J: Treatment of high-risk superficial bladder cancer with maintenance bacille Calmette-Guerin therapy: preliminary results. BJU Int 2002, 89, 620–622.
  5. Stein R, Hohenfellner M, Pahernik S, Roth S, Thuroff JW, Rubben H: Urinary diversion – approaches and consequences. Dtsch Arztebl Int 2012, 109, 617–622.
  6. Asgari MA, Safarinejad MR, Shakhssalim N, Soleimani M, Shahabi A, Amini E: Quality of life after radical cystectomy for bladder cancer in men with an ileal conduit or continent urinary diversion: A comparative study. Urol Ann 2013, 5, 190–196.
  7. Hautmann RE, de Petriconi R, Gottfried HW, Kleinschmidt K, Mattes R, Paiss T: The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol 1999, 161, 422–427; discussion 427–428.
  8. Ardelt PU, Woodhouse CR, Riedmiller H, Gerharz EW: The efferent segment in continent cutaneous urinary diversion: a comprehensive review of the literature. BJU Int 2012, 109, 288–297.
  9. Rink M, Kluth L, Eichelberg E, Fisch M, Dahlem R: Continent Catheterizable Pouches for Urinary Diversion. Eur Urol 2010, Suppl. 9, 754–762.
  10. Yoshimura K, Maekawa S, Ichioka K, Terada N, Matsuta Y, Okubo K, Arai Y: Tubeless cutaneous ureterostomy: the Toyoda method revisited. J Urol 2001, 165, 785–788.
  11. Gerharz EW: Re: Hautmann RE, Abol-Enein H, Hafez K: Urinary diversion. Urology 2007, Suppl. 69, 17–49. Urology 2008, 72, 231–232; author reply 232.
  12. Bricker EM: Bladder substitution after pelvic evisceration. Surg Clin North Am 1950, 30, 1511–1521.
  13. Madersbacher S, Schmidt J, Eberle JM, Thoeny HC, Burkhard F, Hochreiter W, Studer UE: Long-term outcome of ileal conduit diversion. J Urol 2003, 169, 985–990.
  14. Hautmann RE, Miller K, Steiner U, Wenderoth U: The ileal neobladder: 6 years of experience with more than 200 patients. J Urol 1993, 150, 40–45.
  15. Steiner MS, Morton RA: Nutritional and gastrointestinal complications of the use of bowel segments in the lower urinary tract. Urol Clin North Am 1991, 18, 743–754.
  16. McDougal WS: Metabolic complications of urinary intestinal diversion. J Urol 1992, 147, 1199–1208.
  17. Stein R, Schroder A, Thuroff JW: Bladder augmentation and urinary diversion in patients with neurogenic bladder: non-surgical considerations. J Pediatr Urol 2012, 8, 145–152.
  18. Joniau S, Benijts J, Van Kampen M, De Waele M, Ooms J, Van Cleynenbreugel B, Van Poppel H: Clinical experience with the N-shaped ileal neobladder: assessment of complications, voiding patterns, and quality of life in our series of 58 patients. Eur Urol 2005, 47, 666–672; discussion 672–663.
  19. Hofmann AF, Poley JR: Role of bile acid malabsorption in pathogenesis of diarrhea and steatorrhea in patients with ileal resection. I. Response to cholestyramine or replacement of dietary long chain triglyceride by medium chain triglyceride. Gastroenterology 1972, 62, 918–934.
  20. Gonzalez R: Re: Ileocecal valve reconstruction during continent urinary diversion. J Urol 1995, 153, 161–162.
  21. Jacobsen O, Hojgaard L, Hylander Moller E, Wielandt TO, Thale M, Jarnum S, Krag E: Effect of enterocoated cholestyramine on bowel habit after ileal resection: a double blind crossover study. Br Med J (Clin Res Ed) 1985, 290, 1315–1318.
  22. McDougal WS: Bladder reconstruction following cystectomy by uretero-ileo-colourethrostomy. J Urol 1986, 135, 698–701.
  23. Sagalowsky AI, Frenkel EP: Cobalamin profiles in patients after urinary diversion. J Urol 2002, 167, 1696–1700.
  24. Yang WJ, Cho KS, Rha KH, Lee HY, Chung BH, Hong SJ, Yang SC, Choi YD: Long-term effects of ileal conduit urinary diversion on upper urinary tract in bladder cancer. Urology 2006, 68, 324–327.
  25. Davidsson T, Akerlund S, White T, Olaisson G, Mansson W: Mucosal permeability of ileal and colonic reservoirs for urine. Br J Urol 1996, 78, 64–68.
  26. Terai A, Arai Y, Kawakita M, Okada Y, Yoshida O: Effect of urinary intestinal diversion on urinary risk factors for urolithiasis. J Urol 1995, 153, 37–41.
  27. Van der Aa F, Joniau S, Van Den Branden M, Van Poppel H: Metabolic changes after urinary diversion. Adv Urol 2011, 2011, 764325.
  28. Turk TM, Koleski FC, Albala DM: Incidence of urolithiasis in cystectomy patients after intestinal conduit or continent urinary diversion. World J Urol 1999, 17, 305–307.
  29. Terai A, Ueda T, Kakehi Y, Terachi T, Arai Y, Okada Y, Yoshida O: Urinary calculi as a late complication of the Indiana continent urinary diversion: comparison with the Kock pouch procedure. J Urol 1996, 155, 66–68.
  30. Cohen TD, Streem SB, Lammert G: Long-term incidence and risks for recurrent stones following contemporary management of upper tract calculi in patients with a urinary diversion. J Urol 1996, 155, 62–65.
  31. Tanrikut C, McDougal WS: Acid-base and electrolyte disorders after urinary diversion. World J Urol 2004, 22, 168–171.
  32. Gosalbez R, Jr., Woodard JR, Broecker BH, Warshaw B: Metabolic complications of the use of stomach for urinary reconstruction. J Urol 1993, 150, 710–712.
  33. Valtier B, Mion G, Pham LH, Brochard L: Severe hypokalaemic paralysis from an unusual cause mimicking the Guillain-Barre syndrome. Intensive Care Med 1989, 15, 534–535.
  34. Albersen M, Joniau S, Van Poppel H, Cuyle PJ, Knockaert DC, Meersseman W: Urea-splitting urinary tract infection contributing to hyperammonemic encephalopathy. Nat Clin Pract Urol 2007, 4, 455–458.
  35. Ekman I, Mansson W, Nyberg L: Absorption of drugs from continent caecal reservoir for urine. Br J Urol 1989, 64, 412–416.
  36. Fossa SD, Heilo A, Bormer O: Unexpectedly high serum methotrexate levels in cystectomized bladder cancer patients with an ileal conduit treated with intermediate doses of the drug. J Urol 1990, 143, 498–501.
  37. Bettice JA, Gamble JL, Jr.: Skeletal buffering of acute metabolic acidosis. Am J Physiol 1975, 229, 1618–1624.
  38. Arnett TR, Dempster DW: Effect of pH on bone resorption by rat osteoclasts in vitro. Endocrinology 1986, 119, 119–124.
  39. Austen M, Kalble T: Secondary malignancies in different forms of urinary diversion using isolated gut. J Urol 2004, 172, 831–838.
  40. Tollefson MK, Elliott DS, Zincke H, Frank I: Long-term outcome of ureterosigmoidostomy: an analysis of patients with >10 years of follow-up. BJU Int 2010, 105, 860–863.
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