Hypokalemia-associated paralysis and metabolic acidosis in a patient with bilateral ureterosigmoidostomy

Abstract

Ureterosigmoidostomy is a urological intervention performed to treat various conditions such as invasive bladder cancer, bladder exstrophy, vesicovaginal fistula, or urethral trauma. However, this intervention may lead to several metabolic complications. Here, we report an interesting case with quadriparesis and intestinal paralysis resulting from severe hypokalemia (the serum potassium level, 1.8 mEq/L) and hyperchloremic metabolic acidosis [pH 6.927 and the arterial bicarbonate level, 8.0 mEq/L] in a 65-year-old man who had undergone bilateral ureterosigmoidostomy for bladder cancer 16 years earlier. The abdominal computed tomography scan also showed that massive fluid consisting of the mixture of the diverted urinary stream and feces was accumulated in the dilated distal colon. The treatment with intravenous potassium and sodium bicarbonate administration combined with the drainage of the diverted urinary stream from the distal colon resulted in the restoration of hypokalemia and acidosis followed by the improvement of quadriparesis and intestinal paralysis. The underlying mechanism and the treatment of metabolic complications after ureterosigmoidostomy are briefly discussed.

Hypokalaemic quadriparesis in a patient with urinary diversion through Indiana pouch

“…In a case report by Niwa et al , a 65-year-old man who underwent urinary diversion with bilateral ureterosigmoidostomy for bladder carcinoma 16 years ago presented with weakness of all four limbs, similar to the patient in our case report 5. He was diagnosed with hypokalaemia and severe metabolic hyperchloraemic acidosis.…”

“…As reported in previous studies, electrolyte disturbances seen with urinary diversion procedures include hypokalaemia, hypocalcaemia and hypomagnesaemia 2 4 5. Though electrolyte abnormalities in urinary diversion procedures have been reported in many different studies, no long-term epidemiological studies have been done to determine the incidence of these abnormalities.…”

Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction—A Comprehensive Review

“…Although the procedure has been widely used with excellent functional results reaching 80% of day and night continence, it has been abandoned due to the increased risk of metabolic abnormalities, infections, incontinence and secondary malignancy which may appear in up to 40-60% of patients [46,47]. In particular, the most common complications include hydronephrosis, pyelonephritis, anastomosis stenosis (often seen after Coffey's procedure), coloureteral reflux, electrolyte imbalance and osteomalacia [48,49]. Due to these reasons and to the increased rate of colon cancer, which has been reported to be among the 2 and 15%, this technique has been mostly abandoned or conducted as a last resort in selected cases [50][51][52].…”