Preoperative renal scar as a risk factor of postoperative metabolic acidosis following ileocystoplasty in patients with neurogenic bladder

Abstract

Objectives: We investigated relation of preoperative renal scar to incidence of postoperative metabolic acidosis following ileocystoplasty in patients with neurogenic bladder. Patients: Thirty patients with neurogenic bladder, who underwent ileocystoplasty, were enrolled in the present study. Median age at ileocystoplasty was 13.9 years and median follow-up period after ileocystoplasty was 8.2 years. Metabolic acidosis was defined based on the outlined criteria: base excess (BE) is less than 0 mmol l À1 . Preoperative examination revealed that no apparent renal insufficiency was identified in blood analysis, although preoperative 99m Tc-DMSA scintigraphy indicated abnormalities such as renal scar in 14 patients (47%). Incidence of postoperative metabolic acidosis was compared between patients with and without preoperative renal scar, which may reflect some extent of renal tubular damage. Results: Postoperative metabolic acidosis was identified in 13 patients (43%). Incidence of postoperative metabolic acidosis was significantly higher in patients with renal scar (11/14, 79%) compared with patients without renal scar (2/16, 13%; Po0.01). Particularly, all eight patients who had bilateral renal scars showed metabolic acidosis postoperatively. Compared with patients without preoperative renal scar, pH (Po0.05) and BE (Po0.01) were significantly lower postoperatively in patients with preoperative renal scar. However, there was no significant difference in PCO 2 . Hyperchloremia was observed in each patient with or without preoperative renal scar. Conclusion: Incidence of postoperative metabolic acidosis was significantly implicated in preoperative renal scar. If renal abnormalities are preoperatively identified in imaging tests, we need to care patients carefully regarding metabolic acidosis and subsequent comorbidities following ileocystoplasty.

Urinary Tract Infections in Neuro-Patients

“…Complications associated with these procedures are recurrent infection, stone formation, perforation or diverticula, possible malignant changes, metabolic abnormality, mucus production and impaired bowel function [94][95][96]. Special attention should be paid to patients with preoperative renal scars since metabolic acidosis can develop [97]. Several different techniques have been published [98][99][100][101][102][103][104][105][106].…”

Crack Cocaine Use-Related Spinal Cord Infarct

“…Management in this scenario involved a therapy regimen of aspirin and IV corticosteroids, which aimed at reducing further ischemic risk and managing potential inflammatory responses[9]. Following the completion of the immediate therapeutic interventions, the patient was discharged to a rehabilitation facility, highlighting the crucial role of early rehabilitative intervention in improving functional outcomes[10].…”