Urinary Diversion Metabolic Complications – Underestimated Problem

Abstract

Bladder cancer is one of the most frequent human cancers. In 2011 more than six thousand people in Poland developed BC and more than three thousand died because of it. Treatment of bladder cancer depends on its stage. In less advanced tumours (Ta, Tcis, T1) transurethral resection of bladder tumor with adjuvant immunotherapy is often therapeutic. In more advanced cases (≥ T2) radical cystectomy is needed. There are several surgical types of postcystectomy urinary diversion divided into two fundamental types -enabling and not enabling urine continence. The most common procedures include ureterocutaneostomy, ileal or colon conduit, orthopic ileal bladder, heterotopic continent bladder replacement (pouch) and urinary diversion via the rectum. Depending on type of cystectomy, various metabolic complications occur, because the absorptive-secretory function of used bowel segment is intact. Complications include bowel dysfunction, malabsorption of various vitamins, acid-base imbalance, electrolyte imbalance, abnormalities in bone metabolism, formation of renal calculi, secondary malignancies and disturbances in function of kidneys or liver. Early diagnosed complications can be treated easier, recognised in advanced stages are often irreversible. In our paper we present review of different approaches to bladder cancer treatment and metabolic complications occurring after these procedures (Adv Clin Exp Med 2014, 23, 4, 633-638). Bladder cancer (BC) is one of the most frequent human cancers. In 2011 more than six thousand people in Poland developed BC and more than three thousand died because of it. In terms of morbidity in 2011 it was the fifth in male and fifteenth in female cancer in Poland [1]. Frequently, the sole symptom of BC is microscopic or macroscopic haematuria, without any pain or urinary disorders. Other possible symptoms like polyuria or urinary urgency can indicate carcinoma in situ. However, palpable tumor in abdomen, bone pain or weight loss can identify advanced and metastatic cancer.Incidence and prevalence of BC increase with age and exposure to environmental toxins like cigarette smoke. It is proven that smokers have 2 to 6 times grater chance of BC development [2]. Male gender, inflammation, chronic infection of bladder and previous radiotherapy are other predisposing factors.The most common histological type of BC is urothelial cancer. Staging of BC is based on invasion of bladder wall, and is described within TNM (tumor, nodes, metastases) system. Treatment of BC depends on its stage. From a clinical point of view, the most important division is one, which splits into noninfiltrating lamina muscularis tumours (Ta, Tcis, T1) and those infiltrating lamina muscularis (≥ T2). In the first group the procedure of choice is TURB (transurethral resection of bladder tumor), which is diagnostic and often therapeutic. If TURB procedure is insufficient, according to staging and clinical situation, re-TURB or adjuvant immunotherapy can be introduced. In tumours with muscular invasion the method of choi...

Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline

“…40-43 In follow up, vitamin B 12 levels should be assessed as there is an increased risk of deficiency and consequent neurological damage in patients with resection of > 60 cm of ileum and in those patients in whom the terminal ileum is utilized. 44,45 Routine frequent complete blood count and liver function testing for cancer surveillance has not been validated.…”

The Current Use of Stem Cells in Bladder Tissue Regeneration and Bioengineering

“…Patients with bladder malignancies undergo cystectomies with need for new urinary reservoirs. Bowel tissue has generally been accepted as a safe substitute for bladder tissue in these cases, but patients who have bladders reconstructed with intestinal tissue are subject to metabolic disturbances, recurrent infections, bladder stones, and increased risk for malignancy [3]. Furthermore, patients are at risk for intraoperative complications including bowel obstruction arising from the need for bowel anastomoses [4].…”

Sozialmedizinische Begutachtung nach kurativer und adjuvanter Therapie des Harnblasenkarzinoms

“…B. Verdauungsstörungen/Durchfall, Harnwegsinfektion, Urolithiasis, Nierenfunktionseinschränkung (Obstruktion, Infektion), Knochendemineralisation, veränderte Pharmakokinetik, sekundäre Malignome, Vitamin-B12-Mangel sind wichtige Aspekte der fachärztlichen urologischen Nachsorge, haben aber bei "Nichtauftreten" für den primären Begutachtungsprozess keine Relevanz [21]. B. Verdauungsstörungen/Durchfall, Harnwegsinfektion, Urolithiasis, Nierenfunktionseinschränkung (Obstruktion, Infektion), Knochendemineralisation, veränderte Pharmakokinetik, sekundäre Malignome, Vitamin-B12-Mangel sind wichtige Aspekte der fachärztlichen urologischen Nachsorge, haben aber bei "Nichtauftreten" für den primären Begutachtungsprozess keine Relevanz [21].…”