Metabolic bone disease following urinary diversion in adults

Urinary diversions are created following radical cystectomy or for the palliation of recalcitrant lower urinary tract symptoms. Chronic metabolic acidosis, one of the several long-term complications associated with urinary diversion, has been shown to lead to metabolic bone disease if untreated.

The incidence of chronic acidosis can be influenced by several factors, including type and length of bowel segment utilized, renal function, and type of urinary diversion. The observed rate of acidosis has been noted to be high, particularly in patients undergoing continent ileal neobladders using long bowel segments. Results from the five selected case series evaluating the association between urinary diversion and development of metabolic bone disease are inconsistent, but the majority report a low incidence of bone disease, ranging from 0 to 15%. In order to decrease the risk of developing metabolic bone disease and the other associated disorders, attention to the diagnosis of acidosis postoperatively, along with preventive therapy, is crucial. Treatment of acidosis secondary to urinary diversion may be accomplished in the long term with oral alkalizing agents.

Although there is no clear relationship between urinary diversion and the future development of metabolic bone disease, diagnosis and treatment of postoperative acidosis are recommended.