“Urologists who perform urinary diversions should not only be familiar with surgical techniques to create these diversions but should also be aware of metabolic changes that arise when intestinal segments are used to divert or to store urine. Many patients have a long life expectancy, even after oncological surgery with urinary diversion. The advance of medical care makes urinary diversion possible in older, less fit patients with impaired renal function. The duration of contact between urine and bowel, the segment and length of bowel used are factors that determine the nature and grade of metabolic effects. Diversion will result in immediate changes in metabolism.”

“The most popular diversions to date are made from ileal or ileocolonic segments. Noncontinent ileocutaneostomy or Bricker diversion is the most frequently used type of
diversion. This procedure was popularized by Bricker. In this procedure, a conduit is made from approximately 15 to 25 centimeters of preterminal ileum. Reasons for this
popularity over other types of diversion are the relative ease and simplicity of the procedure, the predictable functional results (no risk for incontinence, retention, and catheterization problems), and the fact that this type of diversion results in less metabolic changes (shorter bowel segment, no urinary storage).”

“Urinary diversion is performed frequently in current urological practice. When a diversion is carried out, the patient will undergo metabolic changes. Depending on the bowel segment used, the length of the bowel segment in the type of diversion, these metabolic consequences will be more or less pronounced. An ileal conduit is the diversion of
choice when the metabolic changes want to be kept to a minimum. Even this group of patients will have lower bicarbonate levels and will have episodes of severe acidosis.
Continent urinary diversion (cutaneous or neobladders) will result in longer contact between urine and intestinal segments. These patients will require sodium bicarbonate
substitution. Life-long followup of patients with urinary diversion is mandatory, not only from oncological but also from metabolic perspective.”

Van der Aa, Frank et al. “Metabolic changes after urinary diversion.” Advances in urology vol. 2011 (2011): 764325. Free Full Text