Gastrointestinal function and metabolic control after construction of an orthotopic ileal neobladder in bladder cancer.

TY - JOUR

T1 - Gastrointestinal function and metabolic control after construction of an orthotopic ileal neobladder in bladder cancer.

AU - Thorstenson, Andreas

AU - Jacobsson, Hans

AU - Onelöv, Erik

AU - Holst, Jens Juul

AU - Hellström, Per M

AU - Kinn, Anne-Charlotte

N1 - Keywords: Adult; Aged; Artificial Organs; Bile Acids and Salts; Cystectomy; Female; Gastric Emptying; Glucagon-Like Peptide 1; Humans; Ileum; Male; Middle Aged; Peptide YY; Recovery of Function; Urinary Bladder Neoplasms; Urinary Diversion

PY - 2007

Y1 - 2007

N2 - OBJECTIVE: To investigate the effects of ileum resection in orthotopic neobladder construction on gastrointestinal function and metabolic control. MATERIAL AND METHODS: We included 28 patients who underwent radical cystectomy and construction of an orthotopic neobladder or continent ileal reservoir for bladder cancer. As controls, 10 patients endoscopically treated for non-invasive bladder cancer (TaG2) were enrolled. Gastrointestinal symptoms, enterohepatic bile salt circulation, gastric emptying and gastrointestinal hormones involved in metabolic control were monitored. RESULTS: Of the cystectomy patients, 25% experienced daily diarrhoea and faecal urgency due to bile acid malabsorption, compared to 0% of the controls (p = 0.013). The cystectomy patients experienced faster gastric emptying and had higher levels of peptide YY. Plasma concentrations of insulin, glucagon-like peptide-1 and glucose were unchanged. CONCLUSIONS: Using the distal ileum for orthotopic neobladder construction causes bowel disorders in a quarter of cystectomy patients. Diarrhoea and faecal urgency are probably caused by decreased reabsorption of bile and are not due to changes in gastrointestinal hormones. A sizeable proportion of patients develop bile salt-induced diarrhoea, which can be relieved by treatment with cholestyramine.

AB - OBJECTIVE: To investigate the effects of ileum resection in orthotopic neobladder construction on gastrointestinal function and metabolic control. MATERIAL AND METHODS: We included 28 patients who underwent radical cystectomy and construction of an orthotopic neobladder or continent ileal reservoir for bladder cancer. As controls, 10 patients endoscopically treated for non-invasive bladder cancer (TaG2) were enrolled. Gastrointestinal symptoms, enterohepatic bile salt circulation, gastric emptying and gastrointestinal hormones involved in metabolic control were monitored. RESULTS: Of the cystectomy patients, 25% experienced daily diarrhoea and faecal urgency due to bile acid malabsorption, compared to 0% of the controls (p = 0.013). The cystectomy patients experienced faster gastric emptying and had higher levels of peptide YY. Plasma concentrations of insulin, glucagon-like peptide-1 and glucose were unchanged. CONCLUSIONS: Using the distal ileum for orthotopic neobladder construction causes bowel disorders in a quarter of cystectomy patients. Diarrhoea and faecal urgency are probably caused by decreased reabsorption of bile and are not due to changes in gastrointestinal hormones. A sizeable proportion of patients develop bile salt-induced diarrhoea, which can be relieved by treatment with cholestyramine.

U2 - 10.1080/00365590600911217

DO - 10.1080/00365590600911217

M3 - Journal article

C2 - 17366097

SN - 2168-1805

VL - 41

SP - 14

EP - 19

JO - Scandinavian Journal of Urology

JF - Scandinavian Journal of Urology

IS - 1

ER -