Metabolic acidosis after ileal urinary diversion and radical cystectomy. Do we know as much as we believe? A systematic review

A. Domínguez García*, J. Muñoz Rodríguez, J. Prats López, J. Almirall Daly, C. Centeno Álvarez, L. de Verdonces Roman, C. Pla Terradellas, X. Serra Aracil

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

2 Citations (Scopus)

Abstract

Urine contact with the mucosa of the urinary diversion (UD) after radical cystectomy (RC) produces different ion exchanges that favor the development of metabolic acidosis (MA). This phenomenon is a frequent cause of hospital readmission and short/long-term complications. We performed a systematic review of MA in RCs with ileal UD, analyzing its prevalence, diagnosis, risk factors and treatment. We systematically searched Pubmed® and Cochrane Library for original articles published before May 2022 according to PRISMA guidelines. A total of 421 articles were identified. We selected 25 studies that met the inclusion criteria involving 5811 patients. Obtaining precise data on the prevalence of MA is difficult, largely due to the heterogeneity of the diagnostic criteria used given the diversity of studies analyzed. Development of MA is multifactorial. In the early period, MA is more prevalent in patients with UD with longer ileal segments, better urinary continence, and impaired renal function. Age and diabetes are risk factors associated with MA in later periods. MA is the most common cause of second or more hospital readmissions. Prophylaxis with oral bicarbonate for three months in patients at risk could improve these results. Although MA after ileal UD is a well-known condition, this review highlights the need to implement homogeneous criteria for the diagnosis, follow-up, and treatment, in addition to protocolizing prevention/prophylaxis strategies in patients at risk.

Translated title of the contributionAcidosis metabólica tras cistectomía radical con derivación urinaria ileal. ¿Sabemos tanto como creemos? Revisión sistemática
Original languageEnglish
Pages (from-to)195-210
Number of pages16
JournalActas Urologicas Espanolas
Volume47
Issue number4
DOIs
Publication statusPublished - May 2023

Keywords

  • Bicarbonate
  • Bladder tumor
  • Metabolic acidosis
  • Radical cystectomy
  • Treatment
  • Urinary diversion

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