title: Multi-institutional experience with the gastrointestinal composite reservoir.
abstract: OBJECTIVE
  We evaluated multi-institutional experience with the gastrointestinal composite reservoir in patients with metabolic acidosis, the short bowel syndrome, severe pelvic radiation and/or renal insufficiency.
  
  
  METHODS
  At 4 institutions 33 patients underwent construction of a gastrointestinal composite reservoir, including 19 with the short bowel syndrome, 13 with metabolic acidosis and 7 who also had renal insufficiency. A total of 16 patients underwent conversion of a previous diversion and the remaining 17 received new urinary diversion. Charts were reviewed for the metabolic impact of the gastrointestinal reservoir as well as any long-term sequelae.
  
  
  RESULTS
  At a mean followup of 54 months there was a significant (p < or =0.05) improvement in mean preoperative and postoperative serum chloride (106 versus 102 mEq./l.), serum bicarbonate (23.3 versus 25 mEq./l.) and serum pH (7.36 versus 7.4). Mean serum creatinine did not significantly differ during followup in patients with normal renal function or renal insufficiency. Complications were not different than those of standard intestinal or gastric reservoirs.
  
  
  CONCLUSIONS
  The gastrointestinal reservoir has provided an excellent metabolic balance in a large series of compromised patients with few side effects. We believe that the gastrointestinal composite reservoir represents the urinary diversion of choice when standard intestinal urinary reservoirs cannot be created in the setting of metabolic acidosis, the short bowel syndrome and severe pelvic radiation. However, the value of the gastrointestinal composite in the setting of renal insufficiency remains undetermined.
authors.affiliation: Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: P F
authors.initials: PF
authors.lastname: Austin
authors.forename: J L
authors.initials: JL
authors.lastname: Lockhart
authors.forename: N K
authors.initials: NK
authors.lastname: Bissada
authors.forename: J C
authors.initials: JC
authors.lastname: Hutcheson
authors.forename: H M
authors.initials: HM
authors.lastname: Snyder
authors.forename: R C
authors.initials: RC
authors.lastname: Rink
mesh_terms: D000138:Acidosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000601:surgery*; D012778:Short Bowel Syndrome / Q000601:surgery*; D014547:Urinary Diversion; D016476:Urinary Reservoirs, Continent