Protein-sparing in Cystectomy Patients

Patients undergoing radical cystectomy and urinary diversion for invasive bladder cancer were studied prospectively to evaluate the substitution of crystalline amino acids for dextrose in their postoperative fluid management, and the use of A3W in place of D5W solutions would appear to be indicated.

Abstract

No AccessJournal of Urology1 Mar 1978Protein-sparing in Cystectomy Patients Terry W. Hensle Terry W. HensleTerry W. Hensle More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)57489-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Forty-four patients undergoing radical cystectomy and urinary diversion for invasive bladder cancer were studied prospectively to evaluate the substitution of crystalline amino acids (A3W) for dextrose (D5W) in the postoperative fluid management. Nutritional assessment revealed that 17 (39 per cent) of the 44 patients were malnourished preoperatively, while the postoperative complication rate in group 1 (D5W) was 33 per cent versus 17 per cent in group 2 (A3W). Nitrogen losses in both groups were low, secondary to the large amounts of albumin used postoperatively. However, more exogenous albumin was needed postoperatively to maintain serum albumin levels in group 1 compared to group 2 (77.5 ± 3.1gm. versus 65 ± 5.2gm.). Cell-mediated immunity determined by reactivity to a battery of recall antigens revealed that 56 per cent (5) of the patients in group 1 were able to maintain the skin test reactivity throughout the postoperative course, while 94 per cent (17) of the patients in group 2 maintained reactivity during the same period. Four nutritionally depleted patients in group 1 required conversion to a forced feeding regimen (intravenous hyperalimentation), while none of the group 2 patients required a change in the nutritional regimen. The operative approach to invasive bladder cancer represents a major category of injury. Both preoperative x-ray therapy and the surgical extirpation of this disease are associated with considerable nutritional depletion. Early nutritional support in the management of patients with invasive bladder cancer is mandatory and in those instances when hypocalorie feeding regimens are appropriate the use of crystalline amino acids in place of dextrose solutions would appear to be indicated. © 1978 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByHensle T, Askanazi J, Rosenbaum L, Bernstein G and Kinney J (2018) Metabolic Changes Associated With Radical CystectomyJournal of Urology, VOL. 134, NO. 5, (1032-1036), Online publication date: 1-Nov-1985.Wise G, Altman E, Weiss A, Carr R, Rajaratnam E, Lindsay K and Herz B (2018) Nutritional Support in a General Urological ServiceJournal of Urology, VOL. 131, NO. 2, (302-305), Online publication date: 1-Feb-1984. Volume 119Issue 3March 1978Page: 355-358 Advertisement Copyright & Permissions© 1978 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Terry W. Hensle More articles by this author Expand All Advertisement PDF DownloadLoading ...