Densitometric and Biochemical Alterations in Bony Tissue Induced by Ureterosigmoidostomy

Minervini, R.; Felipetto, R.; Cecchi, Marco; Viganò, L; Fiorentini, L; Ml, Ciompi

doi:10.1159/000282727

Cited by 12 publications

(6 citation statements)

References 3 publications

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“…However, in patients with a continent diversion the role of acidosis and bone disease is less clear. When continent intestinal urinary reservoirs gradually gained popularity at the beginning of the 1990s, the issue was revived in a series of clinical reports, which were mainly retrospective [17–27]. The authors used the terms ‘low‐grade’, ‘mild’, ‘slight’ and ‘subtle’ when qualifying acidosis, with no clear definitions.…”

Section: Bone Diseasementioning

confidence: 99%

“…The authors used the terms ‘low‐grade’, ‘mild’, ‘slight’ and ‘subtle’ when qualifying acidosis, with no clear definitions. Bone demineralization was found in only three series, and in all instances it was minor and asymptomatic [18,21,23]. Despite equally sophisticated methods and a follow‐up of up to 30 years, the other series failed to show such changes, even in the presence of acidosis [17,19,20,22,24–27].…”

Section: Bone Diseasementioning

confidence: 99%

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Metabolic and functional consequences of urinary reconstruction with bowel

et al. 2003

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Section: Bone Diseasementioning

confidence: 99%

Section: Bone Diseasementioning

confidence: 99%

Metabolic and functional consequences of urinary reconstruction with bowel

et al. 2003

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“…However, in the clinical reality of modern continent diversion the role of acidosis and bone disease is less clear. In none of the available contemporary case series was overt derangement of the acid‐base‐balance, rickets or osteomalacia encountered [5–14]. Bone demineralization was found in only three series, in all instances minor and asymptomatic [5,8,10].…”

Section: Discussionmentioning

confidence: 99%

“…Boyd [3] finally proposed a causal link between ureterosigmoidostomy, chronic acidosis and metabolic bone disease. When continent intestinal urinary reservoirs gradually gained popularity, the issue was revived in a series of mostly retrospective clinical investigations [4–14]. At the same time some authors also postulated delayed linear growth [4,15,16] and development [17,18] in children and adolescents undergoing such surgery.…”

Section: Introductionmentioning

confidence: 99%

Skeletal growth and long‐term bone turnover after enterocystoplasty in a chronic rat model

Gerharz

Gasser²,

Mosekilde

et al. 2003

BJU International

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RESULTSMost (90%) of the rats survived the study period (8 months); six rats died from bowel obstruction at the level of the enteroanastomosis and four had to be killed because of persistent severe diarrhoea. Vital intestinal mucosa was found in all augmented bladders. There were no differences in bone length and volume. Loss of bone mass was almost exclusively in rats with ileocystoplasty and resection of the ileocaecal segment ( -37.5%, pQCT, P < 0.01). There was no hyperchloraemic metabolic acidosis or gross impairment of renal function. Hypomagnesaemia, hypocalcaemia and decreased insulin-like growth factor-binding protein 3 were the only significant findings on blood analysis. Deoxypyridinoline crosslinks in urine were higher in rats with an enterocystoplasty than in controls. CONCLUSIONSEnterocystoplasty in rats neither impairs skeletal growth nor bone quantity, but leads to significant loss of bone mass when combined with resection of the ileocaecal segment. Rarefaction of the trabecular network is confined to the metabolically highly active cancellous compartment, most likely as a consequence of intestinal malabsorption. KEYWORDSbone metabolism, urinary diversion, deoxypyridinium crosslinks, dual energy X-ray absorptiometry, peripheral quantitative CT OBJECTIVETo investigate skeletal growth and bone metabolism in a chronic animal model of urinary diversion. MATERIALS AND METHODSYoung male Wistar rats (120) were allocated randomly to four groups undergoing: ileocystoplasty, ileocystoplasty and resection of the ileocaecal segment, colocystoplasty, and controls. All animals received antibiotics for 1 week after surgery; half of each group remained on oral antibiotics. Bone-related biochemistry was measured in serum and urine. Dual-energy X-ray absorptiometry and peripheral quantitative computed tomography (pQCT) were used to determine bone mass ex vivo .

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“…The reabsorption of ammonium from urine as well as secretion of bicarbonate cause endogenous acid load [5]. In metabolic acidosis to maintain a normal acid-base and electrolyte balance, skeletal bone release alkali as calcium, carbonate and sodium which act like a buffer system and this result in alterations of bone mineral metabolism [6,7].…”

Section: Introductionmentioning

confidence: 99%

Effect of stanford pouch and ileal conduit urinary diversions on bone mineral density and metabolism

et al. 2006

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After urinary-intestinal diversions metabolic complications may occur in long term follow up. We aimed to evaluate bone metabolism changes in urinary diverted patients. Nineteen patients with urinary diversions (11 Stanford pouch and 8 ileal conduit) performed with diagnosis of locally invasive bladder cancer and 19 age-sex matched healthy subjects were enrolled in the study. Bone mineral density (BMD), arterial blood pH, bicarbonate and base excess as well as bone mineralisation parameters at urine and serum were evaluated for all groups. For statistical evaluation, nonparametric comparisons between groups were used. Comparison of ileal conduit and control groups displayed higher alkaline phosphatase and parathormone levels in the patient group though the difference was not significant. The mean BMD values of ileal conduit group were osteopenic, revealing a significant difference with the control group. Statistically significant differences between alkaline phosphatase, parathormone levels of Stanford pouch and control groups were apparent whereas BMD values were not significantly different. When the two patient groups were compared with each other, no difference in BMD or bone metabolism parameter values could be observed. Patients with urinary diversions are under risk of bone demineralisation and must be followed by BMDs, arterial blood analysis and bone mineral metabolism parameters.

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Densitometric and Biochemical Alterations in Bony Tissue Induced by Ureterosigmoidostomy

Cited by 12 publications

References 3 publications

Metabolic and functional consequences of urinary reconstruction with bowel

Metabolic and functional consequences of urinary reconstruction with bowel

Skeletal growth and long‐term bone turnover after enterocystoplasty in a chronic rat model

Effect of stanford pouch and ileal conduit urinary diversions on bone mineral density and metabolism

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