Portal de Periódicos da CAPES

No Evidence of Osteopenia 5 to 8 Years After Ileal Orthotopic Bladder Substitution

1996; Lippincott Williams & Wilkins; Volume: 155; Issue: 1 Linguagem: Inglês

10.1016/s0022-5347(01)66543-1

1527-3792

Annie B. Sandberg Tschopp, Kurt Lippuner, Philippe Jaeger, V. Merz, Hansjörg Danuser, Urs E. Studer,

Esophageal and GI Pathology

No AccessJournal of UrologyClinical Urology: Original Article1 Jan 1996No Evidence of Osteopenia 5 to 8 Years After Ileal Orthotopic Bladder Substitution Annie B. Sandberg Tschopp, Kurt Lippuner, Philippe Jaeger, Vincent W. Merz, Hansjorg Danuser, and Urs E. Studer Annie B. Sandberg TschoppAnnie B. Sandberg Tschopp , Kurt LippunerKurt Lippuner , Philippe JaegerPhilippe Jaeger , Vincent W. MerzVincent W. Merz , Hansjorg DanuserHansjorg Danuser , and Urs E. StuderUrs E. Studer View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)66543-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The use of bowel segments as bladder substitutes may result in chronic, impaired vitamin D and calcium metabolism, and ultimately in bone demineralization. Materials and Methods: Bone metabolism was examined in 14 patients who lived for 5 to 8 years with an ileal low pressure bladder substitute after radical cystectomy for bladder cancer. Bone mineral density was measured using dual energy x-ray absorptiometry of the total skeleton, lumbar spine, femoral neck, and tibial epiphysis and diaphysis. Laboratory studies included serum levels of 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D, intact parathyroid hormone, plasma alkaline phosphatase, electrolytes, creatinine and blood gas analysis. Results: Bone mineral density was normal in all patients. There was no evidence of deficient vitamin D stores. There was a tendency toward slightly elevated serum creatinine values in patients with preexisting impaired renal function, including 1 who also had slight acidosis. No patient had hyperchloremia. Conclusions: We found no evidence of osteomalacia, osteoporosis or significant metabolic acidosis in 14 patients with an ileal bladder substitute for 5 to 8 years. However, it is not known whether the absence of osteopenia would also apply to patients with poor renal function, to those not followed meticulously and, thus, at risk for major long-term functional or metabolic disturbances from the ileal bladder substitute or to patients with orthotopic bladder substitutes made from longer or other bowel segments than we used. References 1 : Chronic acidosis secondary to ureteral transplantation. Amer. J. Dis. Child.1931; 42: 366. Google Scholar 2 : The pathophysiology of hyperchloremic metabolic acidosis after urinary diversion through intestinal segments. Surgery1985; 98: 561. Medline, Google Scholar 3 : Clinical significance of intraluminal pH in intestinal ammonia transport. Amer. J. Surg.1970; 119: 595. Google Scholar 4 : The role of ammonia reabsorption in acid-base imbalance following ureterosigmoidostomy. J. Urol.1952; 67: 169. Link, Google Scholar 5 : Inter-relationships of chloride, bicarbonate, sodium, and hydrogen transport in the human ileum. J. Clin. Invest.1970; 49: 557. Google Scholar 6 : Metabolic complications of urologic intestinal substitutes. Urol. Clin. N. Amer.1986; 13: 193. Google Scholar 7 : The pathogenesis and implications of the electrolyte imbalance in ureterosigmoidostomy. Surg., Gynec. & Obst.1956; 103: 736. Medline, Google Scholar 8 : Electrolyte absorption following bilateral uretero-enterostomy into isolated intestinal segment. Ann. Surg.1952; 136: 761. Crossref, Medline, Google Scholar 9 : A newer form of bladder substitute based on historical perspectives. Sem. Urol.1988; 6: 57. Medline, Google Scholar 10 : Ileal low-pressure bladder substitute. Probl. Urol.1991; 5: 316. Google Scholar 11 : Skeletal buffering of acute metabolic acidosis. Amer. J. Physiol.1975; 229: 1618. Google Scholar 12 : Bony demineralization following urinary intestinal diversion. J. Urol.1988; 140: 853. Link, Google Scholar 13 : Effects of pH on bone calcium and proton fluxes in vitro. Amer. J. Physiol.1983; 245: F204. Google Scholar 14 : Changes in bone sodium and carbonate in metabolic acidosis and alkalosis in the dog. J. Clin. Invest.1971; 50: 327. Google Scholar 15 : 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol: conversion impaired by systemic metabolic acidosis. Science1977; 195: 994. Google Scholar 16 : Effect of pH on bone resorption by rat osteoclasts in vitro. Endocrinology1986; 119: 119. Google Scholar 17 : Malabsorption of fat and vitamin B12 before and after intestinal resection for Crohn's disease. Scand. J. Gastroenterol.1978; 13: 529. Google Scholar 18 : Role of fat maldigestion in pathogenesis of steatorrhea in ileal resection. Fat digestion after two sequential test meals with and without cholestyramine. Gastroenterology1976; 71: 38. Google Scholar 19 : Bladder reconstruction with bowel after radical cystectomy. World J. Urol.1992; 10: 11. Google Scholar 20 : Impairment of vitamin D metabolism and bone mineral content after intestinal bypass for obesity. A longitudinal study. Scand. J. Gastroenterol.1984; 19: 184. Google Scholar 21 : Ileal bladder substitute: antireflux nipple or afferent tubular segment? Eur. Urol.1991; 20: 315. Google Scholar 22 : Changes in bone mass early after kidney transplantation. J. Bone Mineral. Res.1994; 9: 1. Google Scholar 23 : Bone mineral density at distal tibia using dual-energy X-ray absorptiometry in normal women and in patients with vertebral osteoporosis or primary hyperparathyroidism. J. Bone Mineral. Res.1994; 9: 1851. Google Scholar 24 : The ileal neobladder. J. Urol.1987; 139: 39. Google Scholar 25 : Correlation between the length of ileum used for a bladder substitute and metabolic acidosis, functional capacity and urinary continence. J. Urol., part 21991; 145: 318A. abstract 423. Google Scholar 26 : Water and electrolyte flux rates in the duodenum, jejunum, ileum and colon and effects of osmolarity. Amer. J. Dig. Dis.1962; 7: 17. Google Scholar 27 : Chemical imbalance following ureterocolic anastomosis. Lancet1952; 2: 599. Crossref, Medline, Google Scholar 28 : Complications of bladder substitution and continent urinary diversion. Urology1989; 34: 329. Google Scholar 29 : Metabolic adaptation of small bowel when used for an ileal bladder substitute. The 18F-FDG absorption test. J. Urol., part 21994; 151: 500A. abstract 1092. Google Scholar Department of Urology and Policlinic of Medicine, University of Berne, Berne, Switzerland.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byHAUTMANN R (2018) Urinary Diversion: Ileal Conduit to NeobladderJournal of Urology, VOL. 169, NO. 3, (834-842), Online publication date: 1-Mar-2003.Studer U (2018) Editorial: Minimizing Morbidity from Reconstructive Bladder SurgeryJournal of Urology, VOL. 157, NO. 6, (2107-2108), Online publication date: 1-Jun-1997.Salomon L, Lugagne P, Herve J, Barre P, Lebret T and Botto H (2018) No Evidence of Metabolic Disorders 10 to 22 Years After Camey Type I Ileal EnterocystoplastyJournal of Urology, VOL. 157, NO. 6, (2104-2106), Online publication date: 1-Jun-1997. Volume 155 Issue 1 January 1996 Page: 71-75 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.Metrics Author Information Annie B. Sandberg Tschopp More articles by this author Kurt Lippuner More articles by this author Philippe Jaeger More articles by this author Vincent W. Merz More articles by this author Hansjorg Danuser More articles by this author Urs E. Studer More articles by this author Expand All Advertisement PDF downloadLoading ...