Pf. Austin et al., LONG-TERM METABOLIC ADVANTAGES OF A GASTROINTESTINAL COMPOSITE URINARY RESERVOIR, The Journal of urology, 158(5), 1997, pp. 1704-1707
Purpose: We investigated the long-term metabolic impact of gastrointes
tinal composite reservoirs, Materials and Methods: Nine patients under
went construction of a gastroileal (7) or gastrocolonic (2) reservoir
for continent urinary diversion. Four cases of metabolic acidosis were
converted from a preexisting conduit and the other 5 patients had div
ersion for either preexisting metabolic acidosis or the short bowel sy
ndrome. All were reconstruct;ed using a medium sized gastric segment (
8 x 4 cm.) from the greater curvature of the stomach. The anti-inconti
nence segment was constructed from a tapered and reimplanted ileal seg
ment. All patients underwent preoperative and postoperative measuremen
ts of serum pH, serum electrolytes, and urinalysis, Serum gastrin was
measured in all patients postoperatively. Followup from surgery ranged
from 47 to 61 months (mean 54.4), Results: All 9 patients demonstrate
d electrolyte neutrality in serum on long-term followup. Postoperative
serum pH (mean 7.40) was significantly different (p<0,01) from preope
rative serum pH (mean 7.36) and serum bicarbonate was also significant
ly different (p<0.01) preoperatively versus postoperatively (mean 22,3
versus 25.14), Urine pH values were not significantly different throu
ghout the study. One patient with mildly acidic urinary pH (6.0 to 6.5
) had ulcerative skin changes at the stoma site, Three patients had el
evated serum gastrin levels on short-term followup but all patients ha
d normal serum gastrin levels on long-term followup. One patient, with
persistent alkaline urine, had urolithiasis and symptomatic urinary t
ract infections, Conclusions: Our results demonstrate that a composite
urinary reservoir constructed using gastric and intestinal segments a
chieved serum electrolyte neutrality on long-term followup. These resu
lts indicate a long-term metabolic advantage over other intestinal res
ervoirs associated with hyperchloremic metabolic acidosis and may be b
eneficial in patients compromised by either preexisting metabolic acid
osis or the short bowel syndrome.