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Metabolische Langzeitprobleme bei der Harnableitung

Metabolic long-term complications after urinary diversion

  • Leitthema
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Zusammenfassung

In der Nachsorge wird den metabolischen Langzeitproblemen und Konsequenzen nach Harnableitung unter der Verwendung von Darmsegmenten wenig Beachtung geschenkt. Subklinische metabolische Störungen treten relativ häufig auf, Komplikationen sind deutlich seltener. Die sezernierenden und absorbierenden Eigenschaften der verwendeten Segmente bleiben nach Inkorporation in den Harntrakt beibehalten, wobei die Resorptionsfläche des verwendeten Darmsegments für die physiologische Funktion des Gastrointestinaltrakts verloren geht.

Die Veränderungen im Elektrolythaushalt sind von dem verwendeten Darmsegment abhängig; wird Ileum oder Kolon verwendet, kann es zur Verminderung des „base excess“ kommen. Komplikationen wie Azidose oder eine Verminderung der Knochendichte können durch einen frühzeitigen prophylaktischen Ausgleich verhindert werden. Für Malabsorbtionssyndrome (Vitamin B12, Gallensäure, fettlösliche Vitamine) kann die Resektion von Ileumsegmenten verantwortlich gemacht werden, bei der Verwendung von Kolonsegmenten sind Elektrolytstörungen häufiger.

Zusammenfassend sind metabolische Veränderungen nach Harnableitung unter Verwendung von Darmsegmenten relativ häufig, schwerwiegenden Komplikationen lassen sich jedoch durch sorgfältige Patientenselektion, konsequente Nachuntersuchungen und frühzeitige medikamentöse Intervention (Alkalisierung bei Azidose, Substitution von Vitamin B12) beherrschen.

Abstract

Metabolic long-term complications and consequences after urinary diversion are somewhat neglected. Subclinical metabolic disturbances are quite common; however, complications are rare. The absorptive surface of the bowel segment is lost for the physiological function of the gastrointestinal tract. Some studies demonstrated that at least some of the absorbent and secreting properties of the bowel are preserved if exposed to urine.

For each bowel segment typical complications are reported. Using ileal and/or colon segments, hyperchloremic metabolic acidosis may occur. Studies demonstrated that metabolic effects are not as severe as suspected and could be prevented if a prophylactic treatment is started early.

The resection of ileal segments is responsible for malabsorption of vitamin B12 and bile acid; when using colonic segments, electrolyte disturbances are more common. Careful patient selection, meticulous follow-up and prophylactic treatment are crucial to prevent metabolic complications.

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  1. Abteilung Kinderurologie, Urologische Klinik und Poliklinik, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    R. Stein, C. Ziesel, S. Frees & J.W. Thüroff

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Stein, R., Ziesel, C., Frees, S. et al. Metabolische Langzeitprobleme bei der Harnableitung. Urologe 51, 507–514 (2012). https://doi.org/10.1007/s00120-012-2816-7

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