ACID-BASE CHANGES FOLLOWING URINARY-TRACT RECONSTRUCTION FOR CONTINENT DIVERSION AND ORTHOTOPIC BLADDER REPLACEMENT

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.