Is chronic alkali therapy in orthotopic ileal neobladders necessary? A prospective controlled study

To evaluate the necessity of chronic alkali therapy in non-complicated orthotopic ileal neobladders with normal renal function.

This is a prospective study that included 200 male patients who underwent radical cystectomy and ileal W neobladder for invasive bladder carcinoma between January 1993 and December 2013. The studied patients included 100 consecutive patients who were maintained on regular alkali therapy since surgery and 100 consecutive patients who stopped the use of alkali treatment after initial 3 months postoperative with minimum postoperative observation time of 1 year. All patients had satisfactory function of the reservoirs with normal upper tract. The patients were subjected to blood analysis for creatnine, electrolytes, pH and bicarbonate and urine chemical analysis. The study also included 40 healthy male age-matched volunteers who served as a control group.

Both groups were comparable as regard age, BMI, follow-up period and surgical technique. There were no significant differences between both groups as regard serum creatnine, electrolytes blood pH and bicarbonate and the mean values were within normal range; however, the neobladder patients are still toward the acidotic side in comparison to healthy volunteers. Also there were no significant differences between both groups of patients as regard urine pH and excretion of electrolytes, calcium, phosphorus and creatnine.

Patients with non-complicated ileal neobladders with normal upper tract who were not maintained on alkali prophylaxis for long period have a compensated acid base status. Therefore, the prolonged alkali prophylaxis is not mandatory.