The gastrointestinal composite urinary reservoir in patients with myelomeningocele and exstrophy: Long-term metabolic followup

Purpose: We investigated the long-term metabolic effects of gastrointestina l composite urinary reservoirs in patients with myelomeningocele or exstrop hy. Materials and Methods: Seven patients with myelomeningocele or exstrophy wh o required complex urinary reconstruction in the setting of metabolic acido sis or the short bowel syndrome underwent construction of a gastrointestina l composite reservoir, including a staged and a single procedure in 3 and 4 , respectively. Preoperatively and postoperatively serum electrolytes were measured, and urinalysis and urine cultures were performed in all patients. In 5 patients serum pH was compared preoperatively and postoperatively, an d in all serum gastrin was measured postoperatively. Results: At an average followup of 62 months (range 52 to 87) serum chlorid e and bicarbonate significantly normalized (p <0.05) in all 7 patients with bladder exstrophy or myelomeningocele. Serum pH also significantly normali zed (p <0.05) in 5 patients at long-term followup. Serum gastrin and creati nine were normal and urinary pH fluctuated insignificantly throughout follo wup. None of the patients had urolithiasis or symptoms of the hematuria-dys uria syndrome. Periodic symptomatic urinary tract infections developed but none required chronic antibiotic therapy. Conclusions: Gastrointestinal composite urinary reservoirs appear to be ben eficial for patients with myelomeningocele or exstrophy who have preexistin g metabolic acidosis or the short bowel syndrome. Serum electrolyte neutral ity is achieved during long-term followup. No patient had the hematuria-dys uria syndrome or urolithiasis.