Association between Development of Metabolic Acidosis and Improvement of Urinary Continence after Ileal Neobladder Creation

No AccessJournal of UrologyAdult Urology1 Mar 2020Association between Development of Metabolic Acidosis and Improvement of Urinary Continence after Ileal Neobladder CreationThis article is commented on by the following:Editorial Comment Guido Müller, Marius Butea-Bocu, Oliver Brock, Julian Hanske, Daniel Pucheril, Joachim Noldus, and Ullrich Otto Guido MüllerGuido Müller *Correspondence: Center for Urological Rehabilitation, Kliniken Hartenstein, Günter-Hartenstein-Straße 8, 34537Bad Wildungen, Germany telephone: +49 5621 75 1011; FAX: +49 5621 75 1102; E-mail Address: [email protected] Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany More articles by this author , Marius Butea-BocuMarius Butea-Bocu Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany More articles by this author , Oliver BrockOliver Brock Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany More articles by this author , Julian HanskeJulian Hanske Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany More articles by this author , Daniel PucherilDaniel Pucheril Department of Urology, Kettering Physician Network, Kettering Medical Center, Dayton, Ohio More articles by this author , Joachim NoldusJoachim Noldus Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany More articles by this author , and Ullrich OttoUllrich Otto Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000583AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Ileal neobladder construction is a common choice for orthotopic urinary diversion following radical cystectomy. We investigated risk factors for metabolic acidosis during the early recovery period. Materials and Methods: This study relied on retrospectively collected data on 345 patients who underwent inpatient rehabilitation after radical cystectomy and ileal neobladder construction for bladder cancer between January 2014 and March 2017. Acid-base status, use of sodium bicarbonate to correct metabolic acidosis and continence status were evaluated at the beginning and end of 3 weeks of inpatient rehabilitation. Multivariate logistic regression analysis was performed to identify risk factors associated with the development of metabolic acidosis. Results: At the start of rehabilitation a median of 29 days after surgery (IQR 23–37) 200 patients (58.0%) had metabolic acidosis. During the inpatient rehabilitation period the need for oral sodium bicarbonate replacement due to acidosis increased significantly from 45.2% to 86.7% of patients (p <0.001) while urine loss measured by a 24-hour pad test decreased significantly from a median of 387 (IQR 98–918) to 88 gm (IQR 5–388, p <0.001). The median base excess was within the normal range (–1.2 mmol/l, IQR –2.4 – 0.0) at the end of inpatient rehabilitation. Decreased urinary leakage was identified as an independent risk factor for metabolic acidosis. Conclusions: The risk of metabolic acidosis after neobladder construction correlated with continuously improved continence in the early recovery period. Therefore, during this period the acid-base status should be assessed more frequently to identify metabolic acidosis. References 1. : ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion. Eur Urol 2013; 63: 67. 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Scand J Urol Nephrol 2007; 41: 261. Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyDec 3, 2019, 12:00:00 AMEditorial Comment Volume 203Issue 3March 2020Page: 585-590Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsurinary bladder neoplasmsrehabilitationurinary diversionacidosiscystectomyMetricsAuthor Information Guido Müller Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany *Correspondence: Center for Urological Rehabilitation, Kliniken Hartenstein, Günter-Hartenstein-Straße 8, 34537Bad Wildungen, Germany telephone: +49 5621 75 1011; FAX: +49 5621 75 1102; E-mail Address: [email protected] More articles by this author Marius Butea-Bocu Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany More articles by this author Oliver Brock Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany More articles by this author Julian Hanske Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany More articles by this author Daniel Pucheril Department of Urology, Kettering Physician Network, Kettering Medical Center, Dayton, Ohio More articles by this author Joachim Noldus Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany More articles by this author Ullrich Otto Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. 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