Does combination of ileal and gastric segments affect the metabolic and histologic outcome after augmentation?

• Published in: Journal of pediatric urology 2007, Vol.3, p.S60-S60
• Main Author: Berk BURGU, Husnu TOKGOZ , Omer GULPINAR , Halit TALAS , Cihan DEMIREL and Tarkan SOYGUR
• Format: Article
• Language: English
• Subjects: Pediatrics; Urology
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2007.01.101

PURPOSE Various intestinal segments are used to reconstruct the urinary tract. Ileal substitutions generally result in hyperchloraemic metabolic acidosis whereas a gastrocystoplasty is recommended for acidotic cases like renal failure since the acid overload can be eliminated. Mucus secretion of ileal segments generally enhance stone formation, however this is rare due to acidic urine after a gastrocystoplasty. We hypothesized that combining the opposite metabolic complications of both segments could prevent certain complications MATERIAL AND METHODS Cystoplasties were performed in 39 rats, using an ileal segment in 11, gastric in 9, combined ileo-gastric in 11 and sham in 8. Each rat underwent 24 hour urine collection in special cages separately for mucus production. Serum/urine electrolytes, acid-base profile and creatinine were measured at 1 month and before sacrifice at 3 months. All augmented bladders were histopathologically evaluated and stones that formed were biochemically analysed RESULTS Mucus production was significantly higher in groups with ileal patches. Gastrointestinal mucosa was found in all augmented bladders. Histopathological examination showed urothelialization of the graft with native transitional epithelium extending over the junctional line. Metaplastic and hyperplastic changes were observed in all segments surrounding urothelium. Metabolic alkalosis with a significantly lower urinary pH were observed in the gastrocystoplasty group. The metabolic status was similar to the control group in bladders with ileal patches. Creatinine levels were similar in all groups. Calcium stone formation occurred in all groups except gastrocytoplasty. CONCLUSIONS Ileocytyoplasty reveals similar outcomes with controls in short-term. Mucus formation occurs less in gastrocystoplasty In the rat model combined ileo-gastrocytoplasty doesn't significantly enhance the metabolic outcome, stone formation and metaplasia with respect to ileocystoplasty alone in short term