The metabolic situation in ureterosigmoidostomy.

At reexamination 67 patients with ureterosigmoidostomies showed no significant alteration of their acid-base and electrolyte metabolism as compared to the preoperative situation and 39 patients with a colonic conduit. If required these patients had received an oral alkali substitution therapy; this proved to be necessary as a permanent measure only in cases with functional and morphological defects of the upper urinary tract. Spells of hyperchloremic acidosis had occurred in 13 patients during the follow-up period and always coincided with attacks of acute pyelonephritis and renal deterioration, often accompanied by irregularities in the substitution. Obviously metabolic problems arise only with a deteriorating urinary tract and timely discovery and treatment of these patients is the main task of the supervising doctor. Although the metabolic imbalances usually respond promptly to an adaptation of the substitution therapy, patients with a predamaged upper urinary tract should not be subjected to ureterosigmoidostomy.