title: Is chronic alkali therapy in orthotopic ileal neobladders necessary? A prospective controlled study.
abstract: OBJECTIVE
  To evaluate the necessity of chronic alkali therapy in non-complicated orthotopic ileal neobladders with normal renal function.
  
  
  METHODS
  This is a prospective study that included 200 male patients who underwent radical cystectomy and ileal W neobladder for invasive bladder carcinoma between January 1993 and December 2013. The studied patients included 100 consecutive patients who were maintained on regular alkali therapy since surgery and 100 consecutive patients who stopped the use of alkali treatment after initial 3 months postoperative with minimum postoperative observation time of 1 year. All patients had satisfactory function of the reservoirs with normal upper tract. The patients were subjected to blood analysis for creatnine, electrolytes, pH and bicarbonate and urine chemical analysis. The study also included 40 healthy male age-matched volunteers who served as a control group.
  
  
  RESULTS
  Both groups were comparable as regard age, BMI, follow-up period and surgical technique. There were no significant differences between both groups as regard serum creatnine, electrolytes blood pH and bicarbonate and the mean values were within normal range; however, the neobladder patients are still toward the acidotic side in comparison to healthy volunteers. Also there were no significant differences between both groups of patients as regard urine pH and excretion of electrolytes, calcium, phosphorus and creatnine.
  
  
  CONCLUSIONS
  Patients with non-complicated ileal neobladders with normal upper tract who were not maintained on alkali prophylaxis for long period have a compensated acid base status. Therefore, the prolonged alkali prophylaxis is not mandatory.
authors: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Osama
authors: O
authors: Mahmoud
authors: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. a_assmy@yahoo.com.
authors: Ahmed
authors: A
authors: El-Assmy
authors: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed
authors: M
authors: Kamal
authors: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Albeer
authors: A
authors: Ashamallah
authors: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Hassan
authors: H
authors: Abol-Enein
mesh_terms: D000138:Acidosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D015653:Cystectomy; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage* / Q000097:blood; D019738:Surgically-Created Structures / Q000009:adverse effects*; D016482:Urinalysis; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*
chemical_list: D017693:Sodium Bicarbonate
keywords: Alkali therapy; Ileal neobladder; Metabolic acidosis; Orthotopic diversion