Purpose: Resection of ileal segments may results in malabsorption and a decrease in intestinal uptake of different substances. The use of intestinal segments in the urinary tract may also cause metabolic disorders. We studied long-term metabolic consequences of enterocystoplasty after radical cystoprostatectomy for bladder cancer.
Materials and methods: We reviewed 17 patients with a Camey type I enterocystoplasty for a mean of 12.9 years (range 10 to 22) after radical cystoprostatectomy. The enterocystoplasty was constructed with a 35 cm. ileal segment resected 20 cm. proximal to the ileocecal valve. All patients underwent complete physical and radiological examinations, including renal ultrasonography and excretory urography. Laboratory studies included blood count with mean corpuscular volume and packed cell volume. Serum was analyzed for electrolytes, hepatic function, cholesterol, triglycerides, albumin, protein, vitamins B12 and B9, iron, ferritin, calcium, phosphate, vitamin D, parathyroid hormone, urea, creatinine, creatinine clearance and prostate specific antigen. In addition urine calcium, protein, creatinine and pH were measured, and a midstream urine specimen was obtained.
Results: There was no evidence of metabolic acidosis, impairment of phosphorus and calcium metabolism, vitamin D deficiency or parathyroid hormone disturbance. All other laboratory tests were within the normal range. Mean creatinine was 106 mumol./l., mean creatinine clearance was 1.5 ml. per second per m.2 and mean prostate specific antigen was 0.2 ng./ml. No patient had post-void residual urine or a dilated upper urinary tract.
Conclusions: This ileal bladder substitute does not induce long-term metabolic anomalies. However, these results may be due to the short ileal length used in the Camey type I technique and the absence of post-void residual urine obtained by good urinary training (that is sustained voiding function).