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Preoperative renal scar as a risk factor of postoperative metabolic acidosis following ileocystoplasty in patients with neurogenic bladder

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Title: Preoperative renal scar as a risk factor of postoperative metabolic acidosis following ileocystoplasty in patients with neurogenic bladder
Authors: Mitsui, Takahiko Browse this author →KAKEN DB
Moriya, Kimihiko Browse this author →KAKEN DB
Kitta, Takeya Browse this author →KAKEN DB
Kon, Masafumi Browse this author
Nonomura, Katsuya Browse this author →KAKEN DB
Keywords: metabolic acidosis
base excess
renal scar
augmentation
bowel
neurogenic bladder
Issue Date: Apr-2014
Publisher: Nature Publishing Group
Journal Title: Spinal Cord
Volume: 52
Issue: 4
Start Page: 292
End Page: 294
Publisher DOI: 10.1038/sc.2013.175
PMID: 24469144
Abstract: Objectives: We investigated relation of preoperative renal scar to incidence of postoperative metabolic acidosis following ileocystoplasty in patients with neurogenic bladder. Patients: Thirty patients with neurogenic bladder, who underwent ileocystoplasty, were enrolled in the present study. Median age at ileocystoplasty was 13.9 years and median follow-up period after ileocystoplasty was 8.2 years. Metabolic acidosis was defined based on the outlined criteria: base excess (BE) is less than 0 mmol l (-1). Preoperative examination revealed that no apparent renal insufficiency was identified in blood analysis, although preoperative Tc-99m-DMSA scintigraphy indicated abnormalities such as renal scar in 14 patients (47%). Incidence of postoperative metabolic acidosis was compared between patients with and without preoperative renal scar, which may reflect some extent of renal tubular damage. Results: Postoperative metabolic acidosis was identified in 13 patients (43%). Incidence of postoperative metabolic acidosis was significantly higher in patients with renal scar (11/14, 79%) compared with patients without renal scar (2/16, 13%; P<0.01). Particularly, all eight patients who had bilateral renal scars showed metabolic acidosis postoperatively. Compared with patients without preoperative renal scar, pH (P<0.05) and BE (P<0.01) were significantly lower postoperatively in patients with preoperative renal scar. However, there was no significant difference in PCO2. Hyperchloremia was observed in each patient with or without preoperative renal scar. Conclusion: Incidence of postoperative metabolic acidosis was significantly implicated in preoperative renal scar. If renal abnormalities are preoperatively identified in imaging tests, we need to care patients carefully regarding metabolic acidosis and subsequent comorbidities following ileocystoplasty.
Type: article (author version)
URI: http://hdl.handle.net/2115/57015
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 三井 貴彦

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