The metabolic situation in ureterosigmoidostomy

Life threatening hypokalemia and quadriparesis in a patient with ureterosigmoidostomy

We report quadriparesis as a result of severe hypokalemia and acidosis in a 15-years-old young man who had undergone ureterosigmoidostomy for bladder extrophy 3 months earlier. The patient was initially mistakenly diagnosed to be a case of Guillain-Barre syndrome. On investigations acidosis and profound hypokalemia were present. Dramatic improvement occurred after correction of hypokalemia and acidosis with intravenous potassium and bicarbonate. The underlying mechanism as well as the treatment of hyperchloremic metabolic acidosis and hypokalemia after ureterosigmoidostomy are hereby discussed.

Gastric conduit urinary diversion in normal dogs. Part I, Upper urinary tract structure, function, and sepsis

The urinary bladder of 10 clinically normal dogs was excised and the ureters were implanted into an isolated, vagotomized gastric segment derived from the fundic region of the stomach. The gastric segment was closed to form a conduit. Continence was maintained with a modified Kock "nipple valve" created from an isolated segment of ileum. Four dogs were euthanatized by day 30 because of complications related to the early onset of renal failure and electrolyte alterations. Six dogs were euthanatized on day 150. Ureteral dilatation, hydronephrosis, and decreased endogenous creatinine clearance rates were measured in all dogs at the end of the survival period. Pyelonephritis was diagnosed histologically in seven dogs. Positive renal cultures were obtained from seven dogs at necropsy. It was concluded that gastric conduit urinary diversion is unsatisfactory for long-term or short-term clinical use in dogs.

Gastric conduit urinary diversion in normal dogs. Part II, Hypochloremic metabolic alkalosis

Gastric conduit urinary diversion was performed in 10 dogs after complete cystectomy. Four dogs were euthanatized on day 30 because of hypochloremic metabolic alkalosis and renal failure. Hematologic and biochemical changes in six dogs evaluated for 120 days were compatible with hypochloremic metabolic alkalosis. The continuous loss of hydrochloric acid from the gastric conduit resulted in significant increases in arterial blood pH, PaCO2, anion gap, TCO2, and the concentration of HCO3-. There were significant decreases in PaO2 and the serum concentrations of chloride and potassium. Deterioration of renal function resulted in all dogs. It was concluded that hypochloremic metabolic alkalosis makes gastric conduit urinary diversion unsatisfactory for clinical use in dogs.