J Korean Med Sci.  2016 Jul;31(7):1100-1104. 10.3346/jkms.2016.31.7.1100.

Febrile Urinary Tract Infection after Radical Cystectomy and Ileal Neobladder in Patients with Bladder Cancer

• Kim KH
• Yoon HS
• Yoon H
• Chung WS
• Sim BS
• Lee DH

• KMID: 2373730
• DOI: http://doi.org/10.3346/jkms.2016.31.7.1100

Abstract

Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.

Keyword

Urinary Bladder Neoplasm; Urinary Diversion; Urinary Tract Infection; Urodynamics

MeSH Terms

Aged
Anti-Bacterial Agents/therapeutic use
Cystectomy/adverse effects
Enterococcus/isolation & purification
Escherichia coli/isolation & purification
Female
Humans
Ileum/*surgery
Incidence
Logistic Models
Male
Middle Aged
Multivariate Analysis
Postoperative Complications
Reconstructive Surgical Procedures
Retrospective Studies
Risk Factors
Urinary Bladder Neoplasms/*surgery
Urinary Tract Infections/drug therapy/*epidemiology/etiology/microbiology
Urodynamics
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Frequencies of implicated pathogen according to postoperative period.

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