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Bladder, bowel and bones—skeletal changes after intestinal urinary diversion

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Abstract

Impaired bone metabolism following urinary diversion through intestinal segments has always been a controversial subject of unclear clinical relevance. Whereas the perpetuated pathophysiological considerations seem conclusive in theory, the role of acidosis and malabsorption is less clear in animal experimentation and, even more so, in the clinical reality of modern continent diversion. In hardly any of the available contemporary case series was overt derangement of the acid-base balance, rickets or osteomalacia encountered. No consistent changes in osteotropic serum parameters could be found with normal calcium and phosphate in all patients. The assumption that colonic reservoirs have a higher risk of developing metabolic bone disease could not be confirmed by clinical data. As early correction of base excess is easy and probably a common policy in patients with intestinal urinary reservoirs, it will be virtually impossible to further study the natural history of bone metabolism after urinary diversion. While there is no need for a bone specific follow-up in asymptomatic adults with a normal acid-base balance, particular attention should be paid to children and to all patients with impaired renal function.

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Authors and Affiliations

  1. Department of Urology, Bavarian Julius Maximilians University Medical School, Josef Schneider Strasse 2, 97080 Würzburg, Germany

    Alexander Roosen & Elmar W. Gerharz

  2. Department of Urology, University of Witten-Herdecke, Wuppertal, Germany

    Stefan Roth

  3. Institute of Urology and Nephrology, Royal Free and University College London Medical School, London, England

    Christopher R. J. Woodhouse

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  1. Alexander Roosen
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  2. Elmar W. Gerharz
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  4. Christopher R. J. Woodhouse
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Correspondence to Alexander Roosen.

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Roosen, A., Gerharz, E.W., Roth, S. et al. Bladder, bowel and bones—skeletal changes after intestinal urinary diversion. World J Urol 22, 200–209 (2004). https://doi.org/10.1007/s00345-004-0434-8

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  • DOI: https://doi.org/10.1007/s00345-004-0434-8

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