Related Experiment Videos
Metabolic consequences of urinary diversion through intestinal segments
M C Hall1, M O Koch, W S McDougal
1Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
The Urologic Clinics of North America
|November 1, 1991
Summary
Urinary tract reconstruction using intestinal segments can cause metabolic acidosis due to acid reabsorption. Newer continent diversions may increase this risk, requiring long-term monitoring for early detection.
Area of Science:
- Urology
- Nephrology
- Gastroenterology
Background:
- Intestinal segments are used for urinary tract reconstruction in various conditions.
- Urine contact with intestinal mucosa can lead to metabolic derangements.
- Metabolic acidosis is a known complication, historically linked to ureterosigmoidostomy.
Purpose of the Study:
- To review the pathophysiology of metabolic acidosis following urinary diversion.
- To assess the risk of metabolic derangements with modern urinary diversion techniques.
- To emphasize the importance of long-term follow-up for detecting subtle metabolic changes.
Main Methods:
- Review of existing literature on urinary diversion and metabolic complications.
- Analysis of the mechanisms of acid reabsorption and bicarbonate secretion.
- Discussion of the clinical implications of different urinary diversion methods.
Main Results:
- Metabolic acidosis primarily results from urinary acid reabsorption as ammonium.
- Conduit urinary diversions reduced the incidence of severe metabolic acidosis compared to ureterosigmoidostomy.
- Continent urinary diversions, while effective, may increase the likelihood of metabolic derangements, especially with renal insufficiency.
Conclusions:
- Modern continent urinary diversions may present an increased risk of metabolic acidosis.
- Mild or asymptomatic acidosis can occur even with normal electrolytes.
- Close, long-term patient follow-up is crucial for determining the significance of metabolic changes.