The effect of intestinal urinary reservoirs on renal function: a 10‐year follow‐up

Abstract

Objective To study the effect of the storage of urine in intestinal reservoirs on long-term renal function and the possible causes of deterioration. Patients and methods Eighty-seven patients (aged 4±35 years) with bladder exstrophy who underwent reconstruction of the lower urinary tract using a bowel segment were enrolled in a prospective protocol. The glomerular ®ltration rate (GFR) was measured before and after surgery at 1, 2, 5 and 10 years using 51 Cr-ethylenediamine tetra-acetic acid. Patients with a decline in GFR of >5% were investigated to identify the cause. Results Of 58 patients with a follow-up of o10 years, 53were evaluable, four having been lost to follow-up and one refusing to accept the protocol. In these 53 patients, the mean (SD) GFR decreased from 97.9 (20.4) to 92.9 (23.6) mL/min/1.73 m 2 (P=0.24). However, this decrease was accounted for by 10 patients (19%) whose GFR fell by o 20% over the 10 years. The causes of renal deterioration in these 10 patients were; chronic retention and/or infection caused by inadequate catheterization in poorly compliant patients (®ve), uretero-ileal stenosis (one), a high-pressure reservoir (one) and uncertain causes (three). Conclusions For 80% of the patients, the storage of urine in intestinal reservoirs did not change renal function for at least 10 years. However, < 20% of patients had some deterioration in renal function during the 10-year follow-up, usually from identi®able and remediable causes. The storage of urine in bowel does not appear to be inherently damaging to kidney function.Patients with an enterocystoplasty need regular monitoring of renal function; when deterioration is detected the urinary tract must be functionally assessed.

Augmentation cystoplasty

“…However, most patients have a stable renal function after augmentation and functional improvement has been noted in up to 4% [23,39]. There is no signi®cant difference in their effect on renal function between ileocystoplasty and colocystoplasty [46,110]. Renal function remained stable or improved, or deteriorated at the same rate after surgery as it was before, in 98% of our series.…”

“…Mucus production can be a problem in patients using CISC and immediately after surgery [110]. The average daily mucus production from both ileum and colon when used as a cystoplasty segment is 35±40 g, and this does not reduce substantially with time, despite a time-related villous atrophy of the intestinal patch mucosa.…”

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

“…10 Regarding renal function after enterocystoplasty, urinary diversion could not deteriorate renal function, although chronic retention or infection caused by inadequate catheterization and poor compliance in urodynamics may deteriorate renal function. 11,12 Actually, two patients, who showed renal insufficiency and metabolic acidosis postoperatively in the present study, already had multiple renal scars and a border value of preoperative serum creatinine in renal function preoperatively, which could be implicated in deterioration of renal function after bladder augmentation.…”

Ileocystoplasty in Rats: Metabolic, Renal and Enteropatch Changes in a Mid- and Long-Term Follow-Up

“…Determination of 51 Cr-EDTA clearance indicated that the glomerular filtration rate decreases somewhat with long-term followup in about 40% of patients with an intestinal urinary reservoir [17]. Miyake et al [14] , analyzing the relation between renal function and acid-base metabolic status in patients who underwent intestinal cystoplasty, documented that metabolic acidosis improves the serum creatinine level.…”