Bone demineralization following urinary intestinal diversion assessed by urinary pyridinium cross-links and dual energy x-ray absorptiometry.
OBJECTIVE
We investigated the acid-base balance and bone mineral status in patients with 3 types of urinary intestinal diversion.


METHODS
Of 46 men with urinary intestinal diversions 20 had a Kock pouch, 15 had an Indiana pouch and 11 had an ileal conduit. Acid-base balance was assessed by arterial blood gas analysis. Bone mineral status was measured by urinary pyridinium cross-links and dual energy x-ray absorptiometry. In addition, urinary deoxypyridinoline was measured in 79 patients.


RESULTS
Of the 46 patients 7 (15%) with the Kock pouch (1), Indiana pouch (5) and ileal conduit (1) had metabolic acidosis associated with significantly lower bone mineral densities (p < 0.05) and higher urinary pyridinium cross-links (p < 0.005) than did those with normal acid-base status. No difference was found in metabolic acidosis and bone demineralization among the 3 groups. Additionally, in 79 patients urinary deoxypyridinoline reached the highest level immediately postoperatively and then gradually decreased to the stable level within 1 or 2 years.


CONCLUSIONS
Metabolic acidosis following urinary intestinal diversion results in bone demineralization. The types of diversion did not cause differences in metabolic acidosis and bone resorption. Bone has a major role in buffering acid overload in the early postoperative period.
Kawakita
M
M
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
Arai
Y
Y
Shigeno
C
C
Terai
A
A
Okada
Y
Y
Takeuchi
H
H
Konishi
J
J
Yoshida
O
O
D015502:Absorptiometry, Photon; D000136:Acid-Base Equilibrium; D000138:Acidosis; D000368:Aged; D000596:Amino Acids / Q000652:urine; D018488:Bone Demineralization, Pathologic / Q000209:etiology* / Q000378:metabolism; D015519:Bone Density; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011726:Pyridinium Compounds / Q000097:blood*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods
D000596:Amino Acids; D011726:Pyridinium Compounds; C036020:deoxypyridinoline