Marius Cristian Butea-Bocu1, Guido Müller2, Oliver Brock2, Ullrich Otto2. 1. Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland. butea-bocu@klinik-quellental.de. 2. Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland.
Abstract
BACKGROUND: In cystectomy patients who underwent neobladder creation, the intestinal mucosa of the neobladder is in constant contact with urine, which may result in chronic metabolic acidosis (CMA) due to specific absorption capabilities of the intestinal mucosa. Despite being a prevalent comorbidity, the risk factors for CMA and its diagnostic parameters are poorly understood. OBJECTIVES: This review examines the risk factors associated with the development of CMA and their prevalence in patients with a neobladder. MATERIALS AND METHODS: We conducted a systematic literature search using the PubMed database to detect studies about the topics CMA and neobladder that were published between 2000 and 2020. The prevalence and risk factors for CMA in neobladder patients were assessed by reviewing 23 studies. RESULTS: Acidosis is most prevalent during the first year after surgery (25-70%). Risk factors are renal failure, high continence, old age and diabetes mellitus. CONCLUSIONS: The prevalence of CMA is at its highest during the early postoperative period for neobladder patients, so for this time period, weekly diagnostic investigations are recommended according to the German S3-guidelines for the "Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinomsent für Neoblasepatienten". Blood gas tests should not only be used to analyze the pH value but also to detect and counteract acid-base imbalance issues in time. The recommended normalization of serum bicarbonate levels with oral bicarbonate follows patient-specific therapy strategies.
BACKGROUND: In cystectomy patients who underwent neobladder creation, the intestinal mucosa of the neobladder is in constant contact with urine, which may result in chronic metabolic acidosis (CMA) due to specific absorption capabilities of the intestinal mucosa. Despite being a prevalent comorbidity, the risk factors for CMA and its diagnostic parameters are poorly understood. OBJECTIVES: This review examines the risk factors associated with the development of CMA and their prevalence in patients with a neobladder. MATERIALS AND METHODS: We conducted a systematic literature search using the PubMed database to detect studies about the topics CMA and neobladder that were published between 2000 and 2020. The prevalence and risk factors for CMA in neobladder patients were assessed by reviewing 23 studies. RESULTS:Acidosis is most prevalent during the first year after surgery (25-70%). Risk factors are renal failure, high continence, old age and diabetes mellitus. CONCLUSIONS: The prevalence of CMA is at its highest during the early postoperative period for neobladder patients, so for this time period, weekly diagnostic investigations are recommended according to the German S3-guidelines for the "Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinomsent für Neoblasepatienten". Blood gas tests should not only be used to analyze the pH value but also to detect and counteract acid-base imbalance issues in time. The recommended normalization of serum bicarbonate levels with oral bicarbonate follows patient-specific therapy strategies.
Authors: Urs E Studer; Fiona C Burkhard; Martin Schumacher; Thomas M Kessler; Harriet Thoeny; Achim Fleischmann; George N Thalmann Journal: J Urol Date: 2006-07 Impact factor: 7.450
Authors: U E Studer; R E Hautmann; M Hohenfellner; R D Mills; Y Okada; R G Rowland; K Tobisu; T Tsukamoto Journal: Urol Oncol Date: 1998 Jul-Oct Impact factor: 3.498