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Metabolic changes associated with radical cystectomy.

T W Hensle, J Askanazi, L H Rosenbaum

    The Journal of Urology
    |November 1, 1985
    PubMed
    Summary
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    Total parenteral nutrition (TPN) significantly improves nitrogen balance and reduces lean tissue loss in patients undergoing radical cystectomy compared to dextrose-only diets. TPN also impacts metabolic responses, including energy expenditure and temperature regulation.

    Area of Science:

    • Metabolic changes
    • Surgical nutrition
    • Oncology

    Background:

    • Radical cystectomy for bladder cancer leads to significant metabolic stress.
    • Nutritional support is crucial for managing surgical recovery and preventing complications.

    Purpose of the Study:

    • To investigate metabolic alterations post-cystectomy.
    • To evaluate the impact of total parenteral nutrition (TPN) versus dextrose infusion on patient recovery.

    Main Methods:

    • Twelve patients undergoing radical cystectomy were randomized into two groups: dextrose infusion (Group I) or TPN (Group II).
    • Nitrogen balance, energy expenditure, respiratory quotient, and norepinephrine excretion were monitored over six postoperative days.

    Main Results:

    Related Experiment Videos

    • Group II (TPN) showed significantly better nitrogen balance (-0.02 gm./kg) compared to Group I (-1.08 gm./kg).
    • TPN increased energy expenditure by 15% and prevented lean tissue losses observed in Group I.
    • TPN patients exhibited elevated norepinephrine and transient temperature increases, suggesting altered metabolic and thermoregulatory responses.

    Conclusions:

    • Total parenteral nutrition effectively mitigates negative nitrogen balance and lean tissue catabolism following radical cystectomy.
    • Nutritional support influences metabolic and thermoregulatory responses, with implications for interpreting fever in critically ill patients.