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Gopalakrishna A, Chang A, Longo TA, Fantony JJ, Harrison MR, Wischmeyer PE, Inman BA. Dietary patterns and health-related quality of life in bladder cancer survivors. Urol Oncol 2018; 36:469.e21-469.e29. [PMID: 30126776 DOI: 10.1016/j.urolonc.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/09/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE A nutritious diet has been associated with better health-related quality of life (HRQOL) in a variety of cancer survivors. However, little is known about dietary habits and its association with HRQOL in bladder cancer survivors. The objective of this cross-sectional study is to describe dietary intake patterns and its relationship to HRQOL in a large cohort of bladder cancer survivors. METHODS Bladder cancer survivors within our institutional database were mailed surveys to assess dietary intake patterns utilizing the Diet History Questionnaire II and assessing HRQOL utilizing the Functional Assessment of Cancer Therapy-Bladder Cancer. Diet quality was assessed via Healthy Eating Index 2010 scores based on subjects' Diet History Questionnaire II results. Univariate and multivariate analyses of HRQOL based on diet quality were used to evaluate whether diet quality was associated with HRQOL. RESULTS Four hundred and fifty-nine patients (48%) returned questionnaires. Mean age was 74 years, 81% were male and 28% underwent radical cystectomy. Diet quality and quantity in our cohort was similar to the general older U.S. population and did not differ significantly between those managed conservatively or long-term following cystectomy. Our cohort had low intake of whole grains and fat-soluble vitamins, particularly vitamin D. Diet quality was significantly associated with HRQOL in the univariate analysis but lost statistical significance in our multivariate analysis. Elixhauser Comorbidity Index was significantly associated with HRQOL in the multivariate analysis. CONCLUSIONS This study demonstrates a similar diet quality of bladder cancer survivors to the older general U.S. population that, on average, "needs improvement." Dietary intake is particularly lacking in whole grain and vitamin D intake. Future studies are warranted to determine the impact on long-term outcome, but bladder cancer survivors should be counseled on the importance and benefits of adherence to dietary guidelines, including its potential contribution toward better HRQOL.
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Affiliation(s)
| | - Andrew Chang
- Division of Urology, Duke University Medical Center, Durham, NC
| | - Thomas A Longo
- Division of Urology, Duke University Medical Center, Durham, NC
| | | | - Michael R Harrison
- Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Paul E Wischmeyer
- Division of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Brant A Inman
- Division of Urology, Duke University Medical Center, Durham, NC.
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Roth JD, Koch MO. Metabolic and Nutritional Consequences of Urinary Diversion Using Intestinal Segments to Reconstruct the Urinary Tract. Urol Clin North Am 2017; 45:19-24. [PMID: 29169447 DOI: 10.1016/j.ucl.2017.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intestinal segments in various forms have been used to reconstruct the urinary tract since the mid-1800s. Currently, many different forms of continent and incontinent diversion options exist. Incorporating bowel mucosa within the urinary tract leads to predictable metabolic and nutritional consequences. The use of ileum or colon can cause a hyperchloremic metabolic acidosis, vitamin B12 deficiency, osteoporosis, fat malabsorption, urinary calculi, and ammoniagenic encephalopathy. Due to metabolic and nutritional consequences associated with the use of jejunum and gastric segments, the use of these bowel segments is not recommended.
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Affiliation(s)
- Joshua D Roth
- Department of Urology, Indiana University School of Medicine, Suite 150 Indiana Cancer Pavilion, 535 North Barnhill Drive, Indianapolis, IN 46202, USA
| | - Michael O Koch
- Indiana University School of Medicine, Suite 150 Indiana Cancer Pavilion, 535 North Barnhill Drive, Indianapolis, IN 46202, USA.
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3
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Abstract
There are several special situations in which urinary lithiasis presents management challenges to the urologist. An in-depth knowledge of the pathophysiology, unique anatomy, and treatment options is crucial in order to maintain good health in these patients. In this review, we summarize the current literature on the management of the following scenarios: bladder stones, stones in bowel disease, during pregnancy, in association with renal anomalies, with skeletal deformities, in urinary diversions, and in children.
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St Clair JW, Wong ML. Ileal Neobladder: An Important Cause of Non-Anion Gap Metabolic Acidosis. J Emerg Med 2017; 52:e179-e182. [PMID: 28169046 DOI: 10.1016/j.jemermed.2016.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/06/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The differential diagnosis for a non-anion gap metabolic acidosis is probably less well known than the differential diagnosis for an anion gap metabolic acidosis. One etiology of a non-anion gap acidosis is the consequence of ileal neobladder urinary diversion for the treatment of bladder cancer. CASE REPORT We present a case of a patient with an ileal neobladder with a severe non-anion gap metabolic acidosis caused by a urinary tract infection and ureteroenterostomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Part of the ileal neobladder surgery includes ureteroenterostomy and predisposes patients to several clinically significant metabolic derangements, including a non-anion gap metabolic acidosis. These patients have an increased chronic acid load, bicarbonate deficit, and hypokalemia, which should be appreciated when resuscitating these patients.
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Affiliation(s)
- Jesse W St Clair
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Matthew L Wong
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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Mahmoud O, El-Assmy A, Kamal M, Ashamallah A, Abol-Enein H. Is chronic alkali therapy in orthotopic ileal neobladders necessary? A prospective controlled study. Int Urol Nephrol 2016; 49:49-53. [PMID: 27785747 DOI: 10.1007/s11255-016-1447-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/24/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the necessity of chronic alkali therapy in non-complicated orthotopic ileal neobladders with normal renal function. MATERIALS AND METHODS This is a prospective study that included 200 male patients who underwent radical cystectomy and ileal W neobladder for invasive bladder carcinoma between January 1993 and December 2013. The studied patients included 100 consecutive patients who were maintained on regular alkali therapy since surgery and 100 consecutive patients who stopped the use of alkali treatment after initial 3 months postoperative with minimum postoperative observation time of 1 year. All patients had satisfactory function of the reservoirs with normal upper tract. The patients were subjected to blood analysis for creatnine, electrolytes, pH and bicarbonate and urine chemical analysis. The study also included 40 healthy male age-matched volunteers who served as a control group. RESULTS Both groups were comparable as regard age, BMI, follow-up period and surgical technique. There were no significant differences between both groups as regard serum creatnine, electrolytes blood pH and bicarbonate and the mean values were within normal range; however, the neobladder patients are still toward the acidotic side in comparison to healthy volunteers. Also there were no significant differences between both groups of patients as regard urine pH and excretion of electrolytes, calcium, phosphorus and creatnine. CONCLUSION Patients with non-complicated ileal neobladders with normal upper tract who were not maintained on alkali prophylaxis for long period have a compensated acid base status. Therefore, the prolonged alkali prophylaxis is not mandatory.
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Affiliation(s)
- Osama Mahmoud
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed El-Assmy
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Mohamed Kamal
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Albeer Ashamallah
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hassan Abol-Enein
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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El-Assmy A, Mahmoud O, Kamal M, Soliman W, Ashamallah A, El-Wakeel N, Abol-Enein H. Characterization of Standard Urine Properties in Noncomplicated Orthotopic Ileal Neobladders: A Prospective Controlled Study. Urology 2016; 96:80-84. [PMID: 27417920 DOI: 10.1016/j.urology.2016.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 05/20/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To characterize the standard physical, chemical, and microscopic characteristics of urine in patients with noncomplicated orthotopic ileal neobladders. MATERIALS AND METHODS This is a prospective study that included 100 male patients who underwent radical cystectomy and ileal neobladder between 1993 and 2013. All included patients were in a good health and having satisfactory function of the reservoirs with normal upper tract with a minimum 1-year postoperative follow-up. We excluded patients with oncological failure, those with diversion-related complications, those who were maintained on clean intermittent catheterization, or those who have symptoms of urinary tract infection. Patients with medical diseases that may affect urine properties (eg, diabetes mellitus) or receiving special medications (eg, diuretics, alkali therapy, or antibiotics) were also excluded. The patients were subjected to urine analysis, blood chemistry, pH, and blood gases; the results were compared to a control group of 40 normal male volunteers. RESULTS Urine analysis in diverted patients showed higher urine pH than in control group but it is still acidic. Pyuria, proteinuria, hematuria, and positive culture were significantly higher in diverted patients. The chemical analysis showed lower urinary calcium, phosphorus, and creatinine contents in diverted patients than in the control group. Serum creatinine was significantly higher in diverted patients, whereas blood pH and bicarbonate were lower, but these values are within normal. CONCLUSION Urine from uncomplicated orthotopic ileal reservoirs is acidic. Pyuria, proteinuria, minor degrees of microscopic hematuria, and positive nitrite reaction are normal findings. We also have normal findings for lower urinary calcium, phosphorus, and creatinine contents in patients.
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Affiliation(s)
- Ahmed El-Assmy
- Urology Department, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Osama Mahmoud
- Urology Department, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Kamal
- Urology Department, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Wafaa Soliman
- Microbiology Department, Delta University for Science and Technology, Mansoura, Egypt
| | - Albeer Ashamallah
- Urology Department, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Hassan Abol-Enein
- Urology Department, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt
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Cano Megías M, Muñoz Delgado EG. Bone and metabolic complications of urinary diversions. ACTA ACUST UNITED AC 2014; 62:100-5. [PMID: 25481805 DOI: 10.1016/j.endonu.2014.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 10/26/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
Abstract
Hyperchloremic metabolic acidosis is a complication of urinary diversion using ileum or colon. Its prevalence ranges from 25% and 46% depending on the procedure used and renal function of the patient. It is a consequence of intestinal fluid and electrolyte exchange between intestinal mucosa and urine. The main mechanism is absorption of ammonium and chloride from urine. Long-term chronic metabolic acidosis in these patients may lead to impaired bone metabolism and osteomalacia. Regular monitoring of pH, chlorine, bicarbonate, and calcium-phosphorus metabolism is therefore essential for early diagnosis and treatment.
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Affiliation(s)
- Marta Cano Megías
- Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - Eva Golmayo Muñoz Delgado
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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Gregg JR, Cookson MS, Phillips S, Salem S, Chang SS, Clark PE, Davis R, Stimson CJ, Aghazadeh M, Smith JA, Barocas DA. Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer. J Urol 2010; 185:90-6. [PMID: 21074802 DOI: 10.1016/j.juro.2010.09.021] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Indexed: 01/13/2023]
Abstract
PURPOSE Poor preoperative nutritional status is a risk factor for adverse outcomes after major surgery. We evaluated the effect of preoperative nutritional deficiency on perioperative mortality and overall survival in patients undergoing radical cystectomy for bladder cancer. MATERIALS AND METHODS A total of 538 patients underwent radical cystectomy for urothelial carcinoma between January 2000 and June 2008, and had nutritional parameters documented. Patients with preoperative albumin less than 3.5 gm/dl, body mass index less than 18.5 kg/m(2) or preoperative weight loss greater than 5% of body weight were considered to have nutritional deficiency. Primary outcomes were 90-day mortality and overall survival. Survival was estimated using Kaplan-Meier analysis and compared using the log rank test. Cox proportional hazards models were used for multivariate survival analysis. RESULTS Of 538 patients 103 (19%) met the criteria for nutritional deficiency. The 90-day mortality rate was 7.3% overall (39 deaths), with 16.5% in patients with nutritional deficiency and 5.1% in the others (p < 0.01). Nutritional deficiency was a strong predictor of death within 90 days on multivariate analysis (HR 2.91; 95% CI 1.36, 6.23; p < 0.01). Overall survival at 3 years was 44.5% (33.5, 54.9) for nutritionally deficient patients and 67.6% (62.4, 72.2) for those who were nutritionally normal (p < 0.01). On multivariate analysis nutritional deficiency cases had a significantly higher risk of all cause mortality (HR 1.82; 95% CI 1.25, 2.65; p < 0.01). CONCLUSIONS Nutritional deficiency, as measured by preoperative weight loss, body mass index and serum albumin, is a strong predictor of 90-day mortality and poor overall survival. Prospective studies are needed to demonstrate the best indices of preoperative nutritional status and whether nutritional intervention can alter the poor prognosis for patients treated with radical cystectomy who have nutritional deficiencies.
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Affiliation(s)
- Justin R Gregg
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Wang XH, Pu XY, Wang HP, Hu LQ. Laparoscopic radical cystectomy with orthotopic gastric neobladder: technique and initial outcomes. J Cancer Res Clin Oncol 2008; 135:197-202. [PMID: 18766376 DOI: 10.1007/s00432-008-0457-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 07/28/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To report our operative technique and initial outcomes of laparoscopic radical cystectomy (LRC) and external orthoptic gastric neobladder. METHODS Since 2003, nine patients have undergone laparoscopic radical cystectomy with orthotopic gastric neobladder at our institution. The specimen is extracted through a 6-cm vertical minilaparotomy incision above the umbilicus. The gastric neobladder was constructed as our open technique using the part of stomach body and antrum with the pedicle of gastroepiploic vascular bundle through the site of specimen retrieval. The operative data, complications and follow-up functional data were analyzed. RESULTS The mean operative time was 365 min (300-450). Mean blood loss was 520 ml (200-1,500) and four patients (44.4%) required blood transfusion. In all cases no conversion to open surgery was necessary. The length of stay was 17 days and the total complication rate was 55.6% (five cases). All patients were free of recurrence at a mean follow-up of 22 months (3-48). The day and night incontinence rate was 11.1 and 44.4%, respectively. At 6 months after operation, urodynamic evaluations indicated a larger capacity, low pressure urinary reservoir. CONCLUSIONS Laparoscopic radical cystectomy with orthotopic gastric neobladder is a feasible intervention. The external construction of the gastric neobladder using the part of stomach body and antrum is quick and safe. With precise and increased operative technique, the LRC with orthotopic gastric bladder may be a good choice for urinary diversion. However, the larger samples, long-term compared studies with bowel diversions are required to evaluate this new technique.
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Affiliation(s)
- Xing-Huan Wang
- Urology and Andrology Center, Zhongnan Hospital, Wuhan University, Number 169, Donghu Road, 430071, Wuhan, Hubei, China.
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Abstract
Crohn's disease frequently can affect the genitourinary system, mainly in the form of urinary fistulae and urolithiasis. Diagnostic evaluation of fistulae associated with Crohn's disease has improved with the increasing use of computed tomography and MR imaging, along with other diagnostic modalities. Resective surgery is the main treatment in this group of patients. Kidney stones are common because of metabolic derangements and dehydration; however, these can be treated adequately with minimally invasive procedures, such as extracorporeal shock-wave lithotripsy, ureteroscopy, and percutaneous surgery. In addition, medical therapies can prevent recurrent stones.
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Affiliation(s)
- A N Manganiotis
- Division of Urology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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