Jl. Lockhart et al., ACID-BASE CHANGES FOLLOWING URINARY-TRACT RECONSTRUCTION FOR CONTINENT DIVERSION AND ORTHOTOPIC BLADDER REPLACEMENT, The Journal of urology, 152(2), 1994, pp. 338-342
A prospective determination of serum electrolytes, arterial blood gase
s, urinalysis and urine cultures was done in 31 patients who underwent
a successful continent urinary reservoir or orthotopic bladder replac
ement. The patients who underwent reconstruction with a long detubular
ized intestinal segment (group 1-50 cm. long) demonstrated the greates
t tendency for metabolic hyperchloremic acidosis (35.2%). In group 2 (
patients with an orthotopic bladder replacement) only 1 individual (16
.7%) had hyperchloremia, which proved to be the sole metabolic derange
ment encountered. In group 3 (individuals with a continent gastroileac
reservoir) 2 patients (25%) had a slight tendency for compensated and
asymptomatic alkalosis. Urinalyses and urine cultures in groups 1 and
2 demonstrated a trend toward urine alkalinity (52.1%) and asymptomat
ic bacteriuria (74%), respectively. On the contrary, among the patient
s undergoing a gastroileac reservoir (group 3), mild urinary acidity (
pH between 5 and 6) was demonstrated in 4 (50%), while asymptomatic ba
cteriuria was present in 3 (37.5%). In this group symptomatic urinary
acidity and/or ulceration of the ileal component has not occurred to d
ate. Metabolic hyperchloremic acidosis predominates when longer coloni
c segments are used for reservoir construction. This abnormality is ma
gnified in patients in whom an accessory small bowel was resected. The
majority of the gastroileac reservoir patients showed electrolytic ne
utrality. With our surgical technique, the gastric secretory propertie
s predominate over those of the ileum. The differences in homeostatic
findings with the use of these varieties of bowel segments suggest tha
t we could modify the final electrolytic environment by using differen
t combinations of bowel and bowel length.