Gastrointestinal function and metabolic control after construction of an orthotopic ileal neobladder in bladder cancer.
OBJECTIVE
To investigate the effects of ileum resection in orthotopic neobladder construction on gastrointestinal function and metabolic control.


METHODS
We included 28 patients who underwent radical cystectomy and construction of an orthotopic neobladder or continent ileal reservoir for bladder cancer. As controls, 10 patients endoscopically treated for non-invasive bladder cancer (TaG2) were enrolled. Gastrointestinal symptoms, enterohepatic bile salt circulation, gastric emptying and gastrointestinal hormones involved in metabolic control were monitored.


RESULTS
Of the cystectomy patients, 25% experienced daily diarrhoea and faecal urgency due to bile acid malabsorption, compared to 0% of the controls (p = 0.013). The cystectomy patients experienced faster gastric emptying and had higher levels of peptide YY. Plasma concentrations of insulin, glucagon-like peptide-1 and glucose were unchanged.


CONCLUSIONS
Using the distal ileum for orthotopic neobladder construction causes bowel disorders in a quarter of cystectomy patients. Diarrhoea and faecal urgency are probably caused by decreased reabsorption of bile and are not due to changes in gastrointestinal hormones. A sizeable proportion of patients develop bile salt-induced diarrhoea, which can be relieved by treatment with cholestyramine.
Thorstenson
Andreas
A
Department of Molecular Medicine, Section of Urology, Stockholm, Sweden. andreas.thorstenson@karolinska.se
Jacobsson
Hans
H
Onelöv
Erik
E
Holst
Jens Juul
JJ
Hellström
Per M
PM
Kinn
Anne-Charlotte
AC
D000328:Adult; D000368:Aged; D001187:Artificial Organs; D001647:Bile Acids and Salts / Q000097:blood; D015653:Cystectomy; D005260:Female; D005746:Gastric Emptying; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019894:Peptide YY / Q000097:blood; D020127:Recovery of Function; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion
D001647:Bile Acids and Salts; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1