The Japanese journal of surgery

, Volume 18, Issue 4, pp 465–468 | Cite as

Prevention of uric acid stone formation by sodium bicarbonate in an ileostomy patient —A case report

  • Tsuneo Fukushima
  • Akira Sugita
  • Shigeyuki Masuzawa
  • Yasunobu Yamazaki
  • Hiroshi Takemura
  • Shuji Tsuchiya
Case Reports


A 38 year old female underwent a proctocolectomy and ileostomy for ulcerative colitis in February, 1974. For 8 year post-operatively, she excreted innumerable renal stones, mainly composed of uric acid. Her urine was highly acidic and hyperuricosuric with a low concentration of sodium. Sodium bicarbonate 4 gm/day, t.i.d., was started in October 1985, after which her renal stone excretion completely ceased (up until March, 1987), except for one incidence of stone excretion when she discontinued therapy for a week. During the sodium bicarbonate therapy, her urinary pH and Na concentration were elevated. Furthermore, sodium bicarbonate significantly elevated the urinary pH and Na concentration of other ileostomy patients. Thus, sodium bicarbonate could be used for the possible prophylaxis of uric acid formation in selected ileostomy patients.

Key Words

ulcerative colitis ileostomy uric acid stone sodium bicarbonate 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kennedy HJ, Fletcher FWL, Truelove SC. Urinary stones in subjects with a permanent ileostomy. Br J Surg 1982; 69: 661–664.PubMedGoogle Scholar
  2. 2.
    Gigax JH, Leach JR. Uric acid calculi associated with ileostomy for ulcerative colitis. J Urol 1971; 105: 797–799.Google Scholar
  3. 3.
    Maratka Z, Nedbal J. Urolithiasis as a complication of the surgical treatment of ulcerative colitis. Gut 1964; 5: 214–217.PubMedGoogle Scholar
  4. 4.
    Knudsen LK, Marcussen H, Fleckenstein P, Pedersen EB, Jarnum S. Urolithiasis in chronic inflammatory bowel disease. Scand J Gastroent 1978; 13: 433–436.PubMedCrossRefGoogle Scholar
  5. 5.
    Deren JJ, Porush JG, Levitt MF, Khilnani MT. Nephrolithiasis as a complication of ulcerative colitis and regional enteritis. Ann Int Med 1962; 56: 843–853.PubMedGoogle Scholar
  6. 6.
    Grossman MS, Nugent FW. Urolithiasis as a complication of chronic diarrheal disease. Am J Dig Dis 1967; 13: 491–498.CrossRefGoogle Scholar
  7. 7.
    Gelzayd EA, Breuer RI, Kirsner JB. Nephrolithiasis in inflammatory bowel disease. Am J Dig Dis 1968; 13: 1027–1034.PubMedCrossRefGoogle Scholar
  8. 8.
    Bennett RC, Hughes ESR. Urinary calculi and ulcerative colitis. Br Med J 1972; 2: 494–496.PubMedCrossRefGoogle Scholar
  9. 9.
    Fukushima T, Ishiguro N, Matsuda Y, Takemura H, Tsuchiya S. Clinical and urinary characteristics of urolithiasis in ulcerative colitis. Am J Gastroent 1982; 77: 238–242.PubMedGoogle Scholar
  10. 10.
    Iwama T, Imajo M, Mishima Y. Urinary calculi associated with total proctocolectomy. Jap J Gastroent 1986; 83: 66–81.Google Scholar
  11. 11.
    Clarke AM, McKenzie RG. Ileostomy and the risk of urinary uric acid stones. Lancet 1969; 2: 395–397.PubMedCrossRefGoogle Scholar
  12. 12.
    Yu T. Urolithiasis in hyperuricemia and gout. J Urol 1981; 126: 424–430.PubMedGoogle Scholar
  13. 13.
    Benson EA, Brannen GE, Bush WH. Urinary tract stones. Postgra Med 1985; 77: 193–198.Google Scholar
  14. 14.
    Clark Am, Chrinside A, Hill GL, Pope G, Stewart MK. Chronic dehydration and sodium depletion in patients with established ileostomies. Lancet 1967; 2: 740–743.CrossRefGoogle Scholar
  15. 15.
    Hill GL, Goligher JC, Smith AM, Mair WSJ. Long term changes in total body water, total exchangeable sodium and total body potassium before and after ileostomy. Br J Surg 1975; 62: 525–527.Google Scholar
  16. 16.
    Turnberg LA, Morris AI, Hawker PC, Herman KJ, Shides RA, North CE. Intracellular electrolytes depletion in patients with ileostomies. Gut 1978; 19: 563–568.PubMedGoogle Scholar
  17. 17.
    Kennedy JH, Lee ECG, Claridge G, Truelove SC. The health of subjects living with a permanent ileostomy. Quart J Med 1982; 51: 341–357.PubMedGoogle Scholar
  18. 18.
    Newton CR, Drurry P, Gonvers JJ, McIntyre P, Preston DM, Lennard-Jones JE. Incidence and treatment of sodium depletion in ileostomists. Scand J Gastroent (supple) 1982; 74: 159–160.Google Scholar
  19. 19.
    Medgcock MW, Eisenberg RL, Williams RD. Antegrade catheter technique to resolve uric acid ureteral calculi. Urol 1982; 19: 407–409.CrossRefGoogle Scholar
  20. 20.
    Blavis JG, Pais VM, Spellman RM. Chemolysis of residual to fragments after extensive surgery for staghorn calculi. Urol 1975; 6: 680–686.CrossRefGoogle Scholar
  21. 21.
    Hardy B, Klein LA. In situ dissolution of ureteral calculus. Urol 1976; 8: 444–446.PubMedCrossRefGoogle Scholar

Copyright information

© The Japan Surgical Society 1988

Authors and Affiliations

  • Tsuneo Fukushima
    • 1
  • Akira Sugita
    • 1
  • Shigeyuki Masuzawa
    • 1
  • Yasunobu Yamazaki
    • 1
  • Hiroshi Takemura
    • 1
  • Shuji Tsuchiya
    • 1
  1. 1.Second Department of SurgeryYokohama City UniversityYokohamaJapan

Personalised recommendations