Metabolic acidosis tied to improvement of urinary continence after neobladder creation

An association exists between the development of metabolic acidosis following ileal neobladder construction and continuous improvement of urinary continence in the early recovery period, reveals a recent study.

During this period, the acid-base status should be assessed more frequently to identify metabolic acidosis, according to the authors.

Of the 345 patients included in the study, 200 (58.0 percent) developed metabolic acidosis at the start of rehabilitation a median of 29 days after surgery (interquartile range [IQR], 23–37).

During the inpatient rehabilitation period, a significant increase was seen in the need for oral sodium bicarbonate replacement due to acidosis, from 45.2 percent to 86.7 percent of patients (p<0.001), whereas urine loss measured by a 24-hour pad test significantly decreased from a median of 387 (IQR, 98–918) to 88 gm (IQR, 5–388; p<0.001).

At the end of inpatient rehabilitation, the median base excess was within the normal range at –1.2 mmol/l (IQR, –2.4 to –0.0). In addition, decreased urinary leakage was found to independently predict the development of metabolic acidosis.

In this study, the authors analysed data retrospectively collected on 345 patients who underwent inpatient rehabilitation following radical cystectomy and ileal neobladder construction for bladder cancer between January 2014 and March 2017. They evaluated acid-base status, use of sodium bicarbonate to correct metabolic acidosis and continence status at the beginning and end of 3 weeks of inpatient rehabilitation.

Risk factors associated with the development of metabolic acidosis were identified through multivariate logistic regression analysis.

“Ileal neobladder construction is a common choice for orthotopic urinary diversion following radical cystectomy,” the authors noted.