TY  - EJOU
AU  - Wada, Naoki 
AU  - Ishimaru, Taichiro 
AU  - Hatakeyama, Tsubasa 
AU  - Ishida, Hajime 
AU  - Takada, Riku 
AU  - Miyauchi, Kotona 
AU  - Abe, Noriyuki 
AU  - Kikuchi, Daiki 
AU  - Ohtani, Miyu 
AU  - Kobayashi, Shin 
AU  - Numakura, Kazuyuki 

TI  - Subacute metabolic acidosis after ileal conduit and radical cystectomy in the era of robotic surgery
T2  - Canadian Journal of Urology

PY  - 
VL  - 
IS  - 
SN  - 1488-5581

AB  -  <b>Backgrounds:</b> Metabolic acidosis (MA) is a known metabolic complication after urinary diversion using intestinal segments, but its occurrence after ileal conduit (IC) has been less well characterized than after orthotopic neobladder. This study aimed to investigate the occurrence of subacute MA following radical cystectomy (RC) and IC in the era of robotic surgery. <b>Methods:</b> Data of patients who underwent RC and IC from January 2014 onward were collected retrospectively. MA was defined as a pH of &lt;7.35 and an HCO<sub>3</sub> level of &lt;22 mEq/L. In addition, the risk factors for developing subacute postoperative MA, including robotic and open surgery, were examined. <b>Results:</b> Ninety-seven patients were included (open 22 [22.7%], robot-assisted 75 [77.3%]). Subacute postoperative MA occurred in 17 patients (17.5%). On simple comparison, MA was observed in 8/22 (36.4%) after open surgery versus 9/75 (12.0%) after robot-assisted surgery (<i>p</i> = 0.008). Patients who developed MA had significantly lower preoperative renal function (median eGFR 39.5 vs. 60.5 mL/min/1.73 m², <i>p</i> &lt; 0.001). In multivariate analysis, renal dysfunction was independently associated with MA, whereas surgical approach was not. Receiver operating characteristic analysis identified an eGFR of 44.3 mL/min/1.73 m² as the optimal cut-off for predicting subacute postoperative MA (AUC 0.79, 95% CI 0.66–0.92). Given variability in assessment timing and institutional practices across the study period, the data do not provide definitive evidence that the surgical approach itself influences MA risk. <b>Conclusion:</b> Subacute MA after RC with IC was not uncommon. Renal impairment was the most important factor associated with its development. Careful postoperative monitoring is warranted, particularly in patients with reduced renal function, even in the robotic surgery era.
KW  - cystectomy; metabolic acidosis; robotic surgery; ileal conduit

DO  - 10.32604/cju.2026.081742