Evaluation of bone mineral density with dual x-ray absorptiometry for osteoporosis in children with bladder augmentation☆
Section snippets
Materials and methods
From July 1996 through July 2001 3 patients with bladder extrophy and one patient with neurogenic bladder underwent colocystoplasty, one patient with neurogenic bladder underwent ureterocystoplasty, and one patient with ureterosigmoidostomy underwent total bladder replacement in the Department of Pediatric Surgery, Karadeniz Technical University School of Medicine. The Sigmoid colon segment was used for colocystoplasty. Bone mineral content and density were measured by DXA (Hologic 2000 DXA).
Results
There were 4 boys and 2 girls. The mean age of the patients at the operation was 13 years (range, 4 years to 20 years). The mean age for the BMD measurements with DXA was 16 years (range, 5 years to 24 years). Blood pH of 5 of 6 patients (83.3%) were lower than 7.35 (range, 7.10 to 7.38). HCO3 levels of all patients were lower than 22 mmol/L (range, 7.1 to 21.6 mmol/L). Ten BMD measurements were obtained for 6 children. One patient (patient 4) who had undergone ureterosigmoidostomy in another
Discussion
Intestinal segments have been used for bladder augmentation and total bladder replacement in patients who have tumor, bladder extrophy, and neurogenic bladder dysfunction.2, 3 Exposure of highly absorptive intestinal mucosa to urine has been associated with multiple metabolic and electrolyte abnormalities, including metabolic acidosis. Ammonium and chloride reabsorption by intestinal mucosa causes hyperchloremic acidosis. Hyperchloremic acidosis leads to mobilization of calcium carbonate from
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2008, Journal of Pediatric SurgeryCitation Excerpt :Thus it was not possible to determine the effect of bladder augmentation itself on skeletal health in these patients. However, none had constant acidosis, which has been suggested to be a risk factor for the development of osteoporosis after bladder augmentation [18,19]. Interestingly, 1 patient who had KCl and NaCl substitution because of a tendency to alkalosis caused by gastrocystoplasty had acidosis at the time of investigation.
The Acid-Base Effects of the Contemporary Western Diet: An Evolutionary Perspective
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2007, Seldin and Giebisch's The Kidney: Physiology & Pathophysiology 1-2Osteoporosis in adults with meningomyelocele: An unrecognized problem at rehabilitation clinics
2006, Archives of Physical Medicine and Rehabilitation
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