Vitamin B12 Deficiency After Irradiation for Bladder Carcinoma

Kinn, Anne‐Charlotte; Lantz, Bo M.T.

doi:10.1016/s0022-5347(17)50695-3

Cited by 45 publications

(16 citation statements)

References 8 publications

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“…In our series, however, a marked deficiency of vitamin Bn in 22% of the evaluated patients was noted, mainly in those patients who received preoperative irradiation. These results, in accordance with those of Kinn and Lantz [8] Stomal complications were frequently mild enough to be managed conservatively. During the last 5 years of the study period, special care was taken to perform a stoma everted 1.5-2.5 cm and thereafter the frequency of stomal complications have declined (data not shown).…”

Section: Early Complicationssupporting

confidence: 91%

“…Malab sorption of vitamin B12 might be expected when the distal part of the ileum is used for diversion procedures. How ever, few studies on this issue [7,8] have been reported after urinary diversion. Although the incidence and the pathophysiology of hyperchloremic acidosis after conti nent reservoir procedures have been extensively studied [9][10][11][12], we have found no reports on the incidence of hyperchloremic acidosis after longlasting ileal conduit diversion.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cystectomy and Urinary Diversion during Twenty Years - Complications and Metabolic Implications

Jahnson

Pedersen

1993

Eur Urol

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Section: Early Complicationssupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Cystectomy and Urinary Diversion during Twenty Years - Complications and Metabolic Implications

Jahnson

Pedersen

1993

Eur Urol

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“…These recommendations can be applied to patients with other forms of pelvic irradiation as well. We have found similar signs of B I 2 malabsorption in patients with bladder carcinoma with increasing frequency in parallel to higher radiation dosages (7).…”

Section: Discussionsupporting

confidence: 72%

Intestinal Damage and Malabsorption after Treatment for Cervical Carcinoma

Lantz

Einhorn

1984

Acta Radiologica: Oncology

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“…Similarly, 30% of patients with an ileal neobladder showed a pathologic Schilling test [10]. Patients who have undergone preoperative irradiation seem to be more prone to vitamin B 12 deficiency as shown by Kinn and Lantz [14] even in patients with an ileal conduit. A recent study comparing 33 patients with an ileocecal reservoir to 13 patients with an ileal reservoir revealed vitmain B 12 levels within the normal range within both groups although both D-xylose and B 12 levels were significantly lower in the ileal reservoir group [15].…”

Section: Vitamin B 12 Absorptionmentioning

confidence: 89%

Follow-Up after Urinary Diversion

Fichtner¹

1999

Urol Int

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With modern forms of urinary diversion being widely employed during recent years, the awareness of possible complications and appropriate follow-up strategies gains rising importance and current follow-up strategies are reviewed herewith. Follow-up investigations after urinary diversion have to address possible surgical complications, metabolic changes as well as the risk of secondary malignancies in the incorporated bowel segments. The most important and possible deleterious surgical complication is upper tract dilation and obstruction following ureteroenteric anastomotic stenosis and occurs in 2–30% depending on the surgical technique and evaluated series. The most appropriate follow-up study to detect upper tract dilation is ultrasonography while the associated obstructional component can best be estimated by functional renographic studies (MAG₃ renal scan). The significance of reflux associated with urinary diversion remains controversial although experimental studies and clinical observations suggest a risk of renal functional deterioration associated with reflux which is certainly true in ureterosigmoidostomy following pyelonephritic changes. Possible metabolic changes include hyperchloremic metabolic acidosis and problems related to malabsorption due to bowel resection and incorporation of bowel segments into the urinary tract. The incidence of hyperchloremic acidosis is related to the form of urinary diversion, being higher in continent forms than in incontinent diversions, while hyperchloremic metabolic acidosis is most frequently encountered in ureterosigmoidostomy. While acute complications of metabolic acidosis may encompass hyperventilation as well as severe changes of serum electrolytes and acid base balance leading to cardiac arrhythmias necessitating immediate hospital treatment with intravenous alkalinizing, chronic acidosis may lead to osteopenia through hypocalcemia and stimulation of osteoclastic activity. Metabolic acidosis can be best detected by regular blood gas analysis. To prevent these complications prophylactic administration of alkalinizing agents (e.g. potassium citrate) should be readily performed. Malabsorption of bile acid strongly correlates with the length of ileum resected and can induce both chologenic diarrhea and malabsorption of liposoluble vitamins (A, D, E, K). Vitamin B₁₂ is exclusively absorbed in the distal ileum, serum levels therefore may be reduced following resection of distal ileum. This will not occur during the first 3–5 years following diversion because B₁₂ deposits usually will last for this period. Later, however, serum levels of vitamin B₁₂ should be checked annually while others favor routine substitution of this vitamin. The incidence of cancer occurring at the ureterointestinal anastomosis seems to be highest in patients with ureterosigmoidostomy varying between 2 and 29% with polypoid benign lesions being more frequent. The most common type of tumor is adenocarcinoma which has also been reported in colonic and...

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Vitamin B12 Deficiency After Irradiation for Bladder Carcinoma

Cited by 45 publications

References 8 publications

Cystectomy and Urinary Diversion during Twenty Years - Complications and Metabolic Implications

Cystectomy and Urinary Diversion during Twenty Years - Complications and Metabolic Implications

Intestinal Damage and Malabsorption after Treatment for Cervical Carcinoma

Follow-Up after Urinary Diversion

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