Abstract
PurposeTo investigate the serial changes of metabolic acidosis and identify associated risk factors in patients who underwent radical cystectomy and ileal neobladder.Material and MethodsFrom January 2010 to August 2014, 123 patients who underwent radical cystectomy and ileal neobladder reconstruction for bladder cancer were included in this study. Metabolic acidosis was defined as a serum bicarbonate level less than 22 mEq/L and impaired renal function was defined as a GFR <50ml/min. The presence of metabolic acidosis was evaluated at 1 month, 1 year, and 2 years after surgery. Multivariate logistic regression analysis was conducted to identify risk factors associated with development of metabolic acidosis.ResultsMetabolic acidosis was observed in 52%, 19.5%, and 7.3% of patients at 1 month, 1 year, and 2 years after surgery, respectively. At 1 month after surgery, impaired renal function was the only independent risk factor associated with metabolic acidosis (OR 3.87, P = 0.046). At 1 year after surgery, diabetes was the only independent risk factor associated with metabolic acidosis (OR 5.68, P = 0.002). At 2 years post-surgery, both age and diabetes were significant risk factors associated with metabolic acidosis.ConclusionApproximately, half of patients experienced metabolic acidosis one month after ileal neobladder reconstruction. Preoperative impaired renal function was the most significant risk factor for developing metabolic acidosis in the early postoperative period. However, the incidence of metabolic acidosis decreased to less than 20% 1 year after surgery, and diabetes was an independent risk factor during this period.
Highlights
Ileal orthotopic neobladder reconstruction is a popular method for urinary diversion after radical cystectomy, and has favorable cosmetic and quality of life outcomes [1,2,3,4]
At 1 month after surgery, impaired renal function was the only independent risk factor associated with metabolic acidosis
At 1 year after surgery, diabetes was the only independent risk factor associated with metabolic acidosis
Summary
Ileal orthotopic neobladder reconstruction is a popular method for urinary diversion after radical cystectomy, and has favorable cosmetic and quality of life outcomes [1,2,3,4]. Neobladder reconstruction is a complicated surgery that is associated with various complications in a substantial proportion of patients. Not all patients are ideal candidates for ileal orthotopic neobladder. The indications for orthotopic neobladder have been broadened, appropriate patient selection is especially important for achieving successful long term results after surgery [5]. Ileal orthotopic neobladder is not indicated in patients with impaired renal function due to their inability to cope with increased acid loads following absorption of urine through ileal neobladder [5, 6]. Patients with reduced renal function are vulnerable to metabolic acidosis and related complications
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