Impaired vitamin B-12 and folate absorption as a risk factor for hyperhomocysteinemia in ileal neobladder

ABSTRACT

The terminal ileum is widely used for reconstruction of the lower urinary tract since the terminal ileum exclusively absorbs vitamin B-12, removal of ileum from the gastrointestinal tract for lower urinary tract reconstruction may predispose patients to vitamin B-12 deficiency. The purpose of this study is to evaluate the long term metabolic and nutritional effects of incorporating intestinal segments in urinary tract on the levels of vitamin B-12 and/or folic acid and their relation with the level of total homocysteine in patients suffering from bladder cancer. This study included twenty seven patients suffering from bladder cancer, with mean age 45 +/- 8.34 years. Twenty one healthy subjects were included in this study to serve as control. The levels of serum vitamin B-12, folic acid and total homocysteine [T-Hcy,] were estimated. Serum T-Hcy level was significantly elevated in pre- and Postoperative patients suffering from bladder cancer when compared to control. The levels of serum vitamin B-12 and folic acid were significantly reduced the drop was markedly increase during 5 months to two years. In conclusion, patients with terminal ileal neobladder reconstruction [5 months - 2 years] of the urinary tract had deficiency of vitamin B-12 and folic acid. Also those patients had hyperhomocysteinemia due to this deficiency. Life long surveillance of vitamin B-12 level annually, that a modest supplement be sampled before twice yearly [by injection may be beneficial and that serum vitamin B-12 must he giving vitamin B-12 injection to avoid cardiovascular disease complication