ABSTRACT

The use of intestine in the urinary tract results in altered solute reabsorption, which has protean manifestations and has the potential to alter normal homeostatic mechanisms. On occasion, however, when intestinal segments are substantial or renal function is compromised, severe and oftentimes debilitating metabolic derangements occur. The chapter considers the metabolic complications of commonly used irrigants in urologic practice. In selected circumstances, when the segment is distended and the patient is dehydrated, the alkalosis can become severe, which is referred to as the syndrome of severe metabolic alkalosis. Patients with urinary intestinal diversions are at a higher risk for development of urinary calculi. This may be due to several mechanisms, which include infection, dehydration, foreign bodies in the reconstructed segment, abnormal mucus production, and increased secretion of calcium and oxalate by the kidney. Patients who have persistent metabolic acidosis are prone to increased bone reabsorption resulting in osteomalasia.