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Kim, Lee, Kim, Ryu, Kim, Kang, Choi, and Lee: Development of Metabolic Acidosis after Neobladder Reconstruction
Original Article

The Ewha Medical Journal 2015; 38(3): 98-105.

Published online: 31 October 2015

DOI: https://doi.org/10.12771/emj.2015.38.3.98

Development of Metabolic Acidosis after Neobladder Reconstruction

Sae-In Kim, Dong Hyeon Lee1, Kwang Hyun Kim1, Dong-Ryeol Ryu, Seung-Jung Kim, Duk-Hee Kang, Kyu Bok Choi, Shina Lee

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

1Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Shina Lee. Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea. Tel: 82-2-2650-5132, Fax: 82-2-2650-2505, cherubic2000@naver.com

Received 6 May 2015       Accepted 2 July 2015

Copyright © 2015, The Ewha Medical Journal

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Metabolic acidosis frequently develops in patients after neobladder reconstruction. However, the incidence of metabolic acidosis in patients with neobladder and the factors associated with the development of metabolic acidosis have not been well elucidated. We aimed to investigate the incidence and the potential predictors for the development of metabolic acidosis after neobladder reconstruction with intestinal segment.

Methods

We included patients who underwent neobladder reconstruction using intestinal segment at Ewha Womans University Mokdong Hospital between January 1, 2005 and December 31, 2014. A subgroup of patients according to the time of metabolic acidosis occurrence was further analyzed in order to characterize predictors for metabolic acidosis.

Results

Metabolic acidosis was encountered in 79.4% of patients with neobladder during follow up period. When patients were divided into 2 groups according to anion gap (AG), total CO2 (18.9±2.1 mEq/L vs. 20.0±1.3 mEq/L, P=0.001) and chloride (106.6±4.9 mE/L vs. 109.4±3.6 mEq/L, P<0.001) were significant different between groups with AG>12 and AG≤12. Furthermore, when patients were divided into 3 groups; patients with metabolic acidosis at postoperative day (POD) 1; from POD 2 to 14 days; after 14 days, there was significant difference among those subgroups.

Conclusion

Our study showed the rate of metabolic acidosis in patients underwent neobladder reconstruction and the difference between patients with metabolic acidosis and those without metabolic acidosis for the first time in Korea. In the future, well designed prospective study will be needed to prevent metabolic acidosis after neobladder reconstruction.

Keywords: Urinay diversion, Metabolic acidosis, Cystectomy

Figures and Tables

Fig. 1

Changes of serum total CO2 (A) and chloride level (B) between preoperative and at the diagnosis of metabolic acidosis in patients who had metabolic acidosis after neobladder replacement operation. Cl, chloride; pre op., preoperative; post op., postoperative.

emj-38-98-g001
Table 1

Baseline characteristics of patients

emj-38-98-i001

Values are presented as mean±standard deviation or number (%).

Table 2

Operation related findings in patients received neobladder replacement

emj-38-98-i002

Values are presented as mean±standard deviation or number (%).

Table 3

Comparisons in patients developed metabolic acidosis after neobladder replacement between normal and increased anion gap

emj-38-98-i003

Values are presented as mean±standard deviation or number (%).

AG, anion gap.

Number of included patients was *107, †68, and ‡39.

Table 4

Comparisons of laboratory findings at diagnosis with metabolic acidosis between normal and increased anion gap

emj-38-98-i004

Values are presented as mean±standard deviation or number (%).

AG, anion gap.

Number of included patients was *149, †89, ‡60, §81, ∥48, and 31.

Table 5

Number of patients according to anion gap and the time of diagnosis with metabolic acidosis

emj-38-98-i005

Values are presented as number (%).

AG, anion gap; POD, postoperative day.

Table 6

Comparisons of baseline variables and preoperative laboratory findings in the patients according to the time of diagnosis with metabolic acidosis

emj-38-98-i006

Values are presented as mean±standard deviation or number (%). ANOVA and Bonferroni tests were applied for comparisons.

POD, postoperative day.

*P=0.043 vs. POD>14. †P=0.046 vs.1<POD≤14. ‡P=0.041 vs. 1<POD≤14.

Table 7

Comparison of laboratory findings in the patients according to the time of diagnosis with metabolic acidosis

emj-38-98-i007

Values are presented as mean±standard deviation or number (%). ANOVA and Bonferroni tests were applied for comparisons.

POD, post operative day.

*P=0.010 vs. POD>14. †P=0.046 vs. POD>14. ‡P=0.002 vs. POD>14. §P=0.008 vs. POD>14. ∥P=0.002 vs. POD≤14. Number of included patients were 47, 20 and 12 in group with POD1, group of 1<POD≤14, and group of POD>14 respectively. **P<0.001 vs. POD>14. ††P=0.012 vs. POD>14.

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