NO EVIDENCE OF METABOLIC DISORDERS 10 TO 22 YEARS AFTER CAMEY TYPE-I ILEAL ENTEROCYSTOPLASTY

Purpose: Resection of ileal segments may result in malabsorption and a decrease in intestinal uptake of different substances. The use of int estinal segments in the urinary tract may also cause metabolic disorde rs. We studied long-term metabolic consequences of enterocystoplasty a fter radical cystoprostatectomy for bladder cancer. Materials and Meth ods: We reviewed 17 patients with a Camey type I enterocystoplasty for a mean of 12.9 years (range 10 to 22) after radical cystoprostatectom y. The enterocystoplasty was constructed with a 35 cm. ileal segment r esected 20 cm. proximal to the ileocecal valve. All patients underwent complete physical and radiological examinations, including renal ultr asonography and excretory urography. Laboratory studies included blood count with mean corpuscular volume and packed cell volume. Serum was analyzed for electrolytes, hepatic function, cholesterol, triglyceride s, albumin, protein, vitamins B12 and B9, iron, ferritin, calcium, pho sphate, vitamin D, parathyroid hormone, urea, creatinine, creatinine c learance and prostate specific antigen. In addition urine calcium, pro tein, creatinine and pH were measured, and a midstream urine specimen was obtained. Results: There was no evidence of metabolic acidosis, im pairment of phosphorus and calcium metabolism, vitamin D deficiency or parathyroid hormone disturbance. All other laboratory tests were with in the normal range. Mean creatinine was 106 mu mol./l., mean creatini ne clearance was 1.5 ml. per second per m.(2) and mean prostate specif ic antigen was 0.2 ng./ml. No patient had post-void residual urine or a dilated upper urinary tract. Conclusions: This ileal bladder substit ute does not induce long-term metabolic anomalies. However, these resu lts may be due to the short ileal length used in the Camey type I tech nique and the absence of post-void residual urine obtained by good uri nary training (that is sustained voiding function).