Serum potassium and creatinine changes following unstented bilateral ureteral reimplantation in children.

OBJECTIVE

We assess the incidence of electrolyte and creatinine changes following unstented bilateral ureteral reimplantation and attempt to identify associated risk factors.

METHODS

A total of 107 consecutive children with bilateral vesicoureteral reflux underwent bilateral unstented ureteral reimplantation. Study exclusion criteria were plication or tapering of any ureter, age less than 1 year and/or baseline serum creatinine greater than twice normal for age. Postoperatively serum electrolytes and creatinine were assessed by venous puncture until values normalized. The presence of nausea, vomiting, urinary retention and oliguria were recorded.

RESULTS

Of the patients 46 females and 10 males 1.0 to 10.9 years old met the study criteria and had complete data available. Four patients (7.1%) had postoperative potassium greater than or equal to 5.0 mmol/l (range 5.0 to 5.3), including 3 (75%, p = 0.0238) who received potassium supplemented intravenous fluid postoperatively. Eight (14.3%) patients had postoperative creatinine greater than 1 mg/dl (range 1.3 to 2.3) and concurrent hyperkalemia with increased creatinine occurred in 2 (25%, p = 0.0295). Nausea and vomiting beyond postoperative day 1 were noted in 6 patients (75%, p = 0.0122). Neither oliguria nor urinary retention reached statistical significance in correlation with increased potassium and/or creatinine. However, urine retention approached statistical significance in patients with increased creatinine (p = 0.0747). No adverse effects from hyperkalemia were noted.

CONCLUSIONS

Adverse effects from hyperkalemia following unstented bilateral ureteral reimplantation are uncommon. Potassium containing intravenous fluids should be avoided in the early postoperative period. Routine serum electrolyte determination may be helpful in patients undergoing unstented bilateral ureteral reimplantation when persistent nausea, emesis or urinary retention is present.