Urinary tract infections in patients with ileal neobladder
Article published in Urologia Polska 2006/59/2.

authors

Tomasz Demkow, Tomasz Wiśniewski, Tomasz Chwaliński: Klinika Nowotworów Układu Moczowego Centrum Onkologii - Instytut w Warszawie

keywords

urinary tract, urinary tract infection, orthotopic neobladder, urinary tract dilatation

summary

Introduction. Indications for reconstruction of urinary tract using intestinal segments have expanded greatly. Orthotopic bladder substitutes creation in patients subjected to radical cystectomy due to bladder cancer is very popular. Clinical data demonstrate significant bacteriuria in patients with orthotopic bladder substitute.

The aim of the study is to assess: the influence of urinary retention on significant bacteriuria following ileal neobladder creation, and to compare the prevalence of urinary infections between the groups of patients who underwent radical prostatectomy and orthotopic bladder creation.

Material. 131 midstream urine samples (MSU) were obtained from 53 patients following orthotopic bladder substitution, and 88 MSU from 44 patients who had undergone radical prostatectomy. 12 healthy controls were included.

Methods. All patients had at least two MSU and abdominal ultrasound investigations.

Results. Among all 131 urine samples taken from patients with neobladder, 89 (68%) were culture negative for bacteria, and 42 (32%) samples were positive. Urinary retention was found in 16 patients. Among all 88 urine samples taken from patients following radical prostatectomy, 80(90,9%) were culture negative for bacteria and 8 (9,1%) samples were positive. There were no urinary retention in the radical prostatectomy group.

Conclusions. Urinary retention in neobladder is considered the important factor for development of urinary tract infection. Significant bacteriuria is more pronounced in neobladder patients' group in comparison to the patients after radical prostatectomy.

references

Celayir S, Göksel S, Ünal T: Helicobacter pylori Infection in a Child With Gastric Augmentation. J Ped Surg 1999, 34, 532-535.
Celayir S, Göksel S: The Relationship Between Helicobacter pylori Infection and Acid - Hematuria Syndrome in Pediatric Patients With Gastric Augmentation. Journal of Pediatric Surgery, Vol 34, No 4, 1999: pp 532-535.
Paiss T, Gschwend J, Gottfried HW, Hautmann RE: Die Signifikanz der Bakteriuri bei der Ileum-Neoblase. Urologe A 1995, Supplement 1/95, 49.
Studer UE, Zingg EJ: Ileal orthotopic bladder substitutes. What we have learned from 12 years , experience with 200 patients. Urol Clin North Am 1997, 24 (4): 781-793.
Steven K, Poulsen AL: The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol 2000,164 (2), 288-295.
Werner W. Hochreiter, Sebastion Z'Brun: UTI and Urinary Tract Reconstruction. EAU Update Series 2004, 2, 101-105.
Akerlund S, Campanello M, Kaijser B, Jonsson O: Bacteriuria in patients with a continent ileal reservoir for urinary diversion does not regularly require antibiotic treatment. Br J Urol 1994, 74 (2), 177-181.
Wullt B, Holst E, Steven K et al: Microbial Flora in IIeal and Colonic Neobladders. Eur Urol 2004, 45, 233-239.
Studer UE, Danuser H, Hochreiter W et al: Summary of 10 years' experience with an ileal low-pressure bladder substitute combined with an afferent tubular isoperistaltic segment. World J Urol 1996, 14: 29-39.
McDougal WS: Use of intestinal segments and urinary diversion. In Walsh PC, Retik AB, Vaughan Jr ED, Wein AJ, editors. Campbell's Urology, 7th edn. Philadelphia: Saunders, 1998, p. 3121-3161.
Iwakiri J, Freiha S F, Shortliffe LMD: Prospective study of urinary tract infections and urinary antibodies after radical prostatectomy and cystoprastatectomy. Urol Clin North Am 2002, 29, 251-258.
Stamey TA: Pathogenesis and Treatment of Urinary Tract Infections. Baltimore, Williams and Wilkins, 1980, 146-150.
Ablin R, Gonder M, Soanes W: Localization of immunoglobulins in human prostatic tissue. J Immunol 1971, 107, 603-604.
Grayhack J, Wendel E, Oliver L: Analysis of specific proteins in prostatic fluid for detecting prostatic malignancy. J Urol 1979, 121, 295-299.
Mansson W, Colleen S, Low K, et al: Immunoglobulins in urine from patients with ileal and colonic conduits and reservoirs. J Urol 1985, 133, 713-716.
Brandtzaeg P: Immunology of the human gastrointestinal tract in health and disease - a brief review. Keio J Med 1988, 37, 168-176.
Woodside J, Reed W, Borden T: Immunoglobulin in urine from ileal conduit and nephrostomy patients. Invest Urol 1979, 16, 473-475.

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