Marked Metabolic Acidosis Due to a Transverse Stoma After Urethroplasty for Congenital Epispadias

Overview

Journal Intern Med

Specialty General Medicine

Date 2023 May 10

PMID 37164676

Authors

Mariko Yamauchi

Sahoko Kamejima

Risa Ueda

Akio Nakashima

Fumihiko Urabe

Izumi Yamamoto

Ichiro Ohkido

Takashi Yokoo

Affiliations

Soon will be listed here.

Abstract

A 58-year-old woman was admitted to our hospital. At 10 years old, she had undergone bilateral uretero-sigmoid anastomosis for congenital epispadias, and at 57 years old, she had received transverse colostomy. Biochemical tests showed marked metabolic acidosis. Computed tomography showed urine stagnation in the sigmoid colon, leading to a diagnosis of metabolic acidosis associated with transverse stoma after bilateral uretero-sigmoid anastomosis. Her bone mineral density was below normal, and the bone metabolic marker levels were high, indicating high-turnover osteoporosis. Both metabolic acidosis and bone metabolism were stabilized by treatment with a transanal urinary catheter, sodium bicarbonate, and vitamin D.

Citing Articles

Relationship between albumin-corrected anion gap and lumbar spine bone mineral density: a cross-sectional study.

Liu A, Ying T, Deng S, Wang C, Zhao Z, Zhang S Front Aging. 2025; 6:1511294.

PMID: 40007853 PMC: 11850363. DOI: 10.3389/fragi.2025.1511294.

References

Hafez A, McLorie G, Gilday D, Laudenberg B, Upadhyay J, Bagli D . Long-term evaluation of metabolic profile and bone mineral density after ileocystoplasty in children. J Urol. 2003; 170(4 Pt 2):1639-41. DOI: 10.1097/01.ju.0000083887.58315.7e. View

Bischoff-Ferrari H, Willett W, Wong J, Stuck A, Staehelin H, Orav E . Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med. 2009; 169(6):551-61. DOI: 10.1001/archinternmed.2008.600. View

Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Kostenberger M, Tmava Berisha A . Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020; 74(11):1498-1513. PMC: 7091696. DOI: 10.1038/s41430-020-0558-y. View

Krajewski W, Piszczek R, Krajewska M, Dembowski J, Zdrojowy R . Urinary diversion metabolic complications - underestimated problem. Adv Clin Exp Med. 2014; 23(4):633-8. DOI: 10.17219/acem/28251. View

Holick M, Binkley N, Bischoff-Ferrari H, Gordon C, Hanley D, Heaney R . Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96(7):1911-30. DOI: 10.1210/jc.2011-0385. View

Matsumoto T, Ito M, Hayashi Y, Hirota T, Tanigawara Y, Sone T . A new active vitamin D3 analog, eldecalcitol, prevents the risk of osteoporotic fractures--a randomized, active comparator, double-blind study. Bone. 2011; 49(4):605-12. DOI: 10.1016/j.bone.2011.07.011. View

Gallagher J, Fowler S, Detter J, Sherman S . Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss. J Clin Endocrinol Metab. 2001; 86(8):3618-28. DOI: 10.1210/jcem.86.8.7703. View

Jehle S, Zanetti A, Muser J, Hulter H, Krapf R . Partial neutralization of the acidogenic Western diet with potassium citrate increases bone mass in postmenopausal women with osteopenia. J Am Soc Nephrol. 2006; 17(11):3213-22. DOI: 10.1681/ASN.2006030233. View

Shiraki M, Kushida K, Fukunaga M, Kishimoto H, Taga M, Nakamura T . A double-masked multicenter comparative study between alendronate and alfacalcidol in Japanese patients with osteoporosis. The Alendronate Phase III Osteoporosis Treatment Research Group. Osteoporos Int. 1999; 10(3):183-92. DOI: 10.1007/s001980050214. View

10.

Hensle T, Reiley E, Fam M, Carpenter C . Enterocystoplasty: The long-term effects on bone mineral density. J Pediatr Urol. 2016; 12(4):245.e1-6. DOI: 10.1016/j.jpurol.2016.02.017. View

11.

Krieger N, Frick K, Bushinsky D . Mechanism of acid-induced bone resorption. Curr Opin Nephrol Hypertens. 2004; 13(4):423-36. DOI: 10.1097/01.mnh.0000133975.32559.6b. View

12.

Jehle S, Hulter H, Krapf R . Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab. 2012; 98(1):207-17. DOI: 10.1210/jc.2012-3099. View

13.

Papadimitropoulos E, Wells G, Shea B, Gillespie W, Weaver B, Zytaruk N . Meta-analyses of therapies for postmenopausal osteoporosis. VIII: Meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev. 2002; 23(4):560-9. DOI: 10.1210/er.2001-8002. View

14.

Lenis A, Lec P, Chamie K . Urinary Diversion. JAMA. 2020; 324(21):2222. DOI: 10.1001/jama.2020.17604. View

15.

Van der Aa F, Joniau S, Van den Branden M, van Poppel H . Metabolic changes after urinary diversion. Adv Urol. 2011; 2011:764325. PMC: 3113422. DOI: 10.1155/2011/764325. View

16.

BRICKER E . Bladder substitution after pelvic evisceration. Surg Clin North Am. 1950; 30(5):1511-21. DOI: 10.1016/s0039-6109(16)33147-4. View

17.

Dawson-Hughes B, Harris S, Palermo N, Castaneda-Sceppa C, Rasmussen H, Dallal G . Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women. J Clin Endocrinol Metab. 2008; 94(1):96-102. PMC: 2630872. DOI: 10.1210/jc.2008-1662. View

18.

McDougal W . Metabolic complications of urinary intestinal diversion. J Urol. 1992; 147(5):1199-208. DOI: 10.1016/s0022-5347(17)37517-1. View

19.

Martineau A, Jolliffe D, Hooper R, Greenberg L, Aloia J, Bergman P . Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017; 356:i6583. PMC: 5310969. DOI: 10.1136/bmj.i6583. View

20.

Gasser J, Hulter H, Imboden P, Krapf R . Effect of chronic metabolic acidosis on bone density and bone architecture in vivo in rats. Am J Physiol Renal Physiol. 2013; 306(5):F517-24. DOI: 10.1152/ajprenal.00494.2013. View