BILE-ACID MALABSORPTION AFTER CONTINENT URINARY-DIVERSION WITH AN ILEAL RESERVOIR

Purpose: We determine the effect of urinary diversion with a Kock ilea l reservoir on bile acid absorption and bowel habits. Materials and Me thods: We asked 96 patients with a Kock ileal urinary reservoir to rec ord bowel habits and abdominal symptoms for 1 week. Data on 75 patient s were further analyzed. Bile acid absorption was determined in 29 hea lthy control subjects, in 17 before and 6 months after continent urina ry diversion, and in 21, 2 to 14 years postoperatively. Bile acid abso rption was considered pathological when retention of less than 10% of an oral capsule containing selenium-75 labeled tauroselcholic acid (Se HCAT) was noted after 1 week. Results: Mean number of defecations plus or minus standard deviation was 9.4 +/- 6.1 (75 cases). Of the patien ts 13% had 15 or more stools per week and 15% complained of always hav ing loose stools. Mean value for the SeHCAT test was 32 +/- 19% preope ratively and 17 +/- 16% 6 months postoperatively (p = 0.0023). The cor responding value for healthy controls was 39 +/- 18%. Significant rela tionships were found between the results of the SeHCAT test postoperat ively, and the number of stools per week and consistency of the feces. All patients with more than 10 defecations per week had a pathologica l SeHCAT test. Conclusions: Most patients with an ileal urinary reserv oir have fairly normal, bowel habits. Bile acid absorption is signific antly reduced postoperatively and approximately a third of the patient s have a pathological SeHCAT test. Preoperative investigation of bowel habits is recommended and a SeHCAT test should be performed in patien ts with frequent, loose defecations. Other types of diversion should b e offered when preoperative retention is below 10 to 20% especially in patients with impaired anal control.