LONG-TERM METABOLIC EFFECTS IN PATIENTS WITH URINARY-DIVERSION

The use of intestinal segments in genitourinary reconstruction could i nfluence vitamin metabolism and affect the skeletal bone and its miner al content in the long term. In 137 patients, serum levels of the vita mins A, B-1, B-2, B-6, B-12, D, and E and of folic acid, bile acid, an d ammonia as well as levels of intracorpuscular vitamin B-12 and folic acid were examined and a red blood cell count was performed. The pati ents were divided into three groups (less than or equal to 2 years, >2 to less than or equal to 4 years, and >4 years after surgery) as well as into children and adults. In addition, bone mineral density (dual- photon absorptiometry) was measured in 25 patients. Of these, 16 patie nts were approximate to 16.8 years s/p rectal reservoir, 6 were approx imate to 20.5 years s/p colonic conduit, two were 6 and 8 years s/p il eocecal pouch, and one adolescent was 5 years s/p ileal bladder augmen tation. In all patients the levels of vitamins A, B-1, B-2, B-6, D, an d E and of folic acid, bile acid, and ammonia as well as the red blood cell count were within normal ranges. In children (n = 51) there was no significant drop in vitamin B-12 levels after the operation. In adu lts (n = 86), serum vitamin B-12 levels dropped significantly from 402 +/- 182 ng/l during the first 2 years after the operation to 292 +/- 204 ng/l after the 4th year (normal range 240-1,100 ng/l). No signific ant increase in the intracorpuscular vitamin B-12 level was observed d uring the same period. The bone mineral density was normal in all 25 p atients with different types of urinary diversion. In addition to regu lar examination (sonography, creatinine levels, and base excess), vita min Bit levels should be determined at 4 years after urinary diversion . It remains unclear whether substitution is necessary. However, subst itution is easy to achieve and cheaper than the regular determination of vitamin B12 No decrease in bone mineral content was seen in the lon g-term follow-up with early correction of the base excess (below -2.5) .